Guan Bao, Zhang Jianye, Chen Silu, Wang Guoli, Du Yicong, Tao Zihao, Xu Chunru, Tang Qi, Yang Yi, Zhou Liqun, Li Xuesong, Li Xiaoying
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
The First Hospital of Fangshan District, Beijing, China.
Int J Surg. 2025 Jul 3. doi: 10.1097/JS9.0000000000002892.
This study aimed to evaluate the prognostic significance of synchronous and metachronous bladder cancer (BCa) in Chinese patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU).
We retrospectively analyzed clinicopathological data from 2921 consecutive nonmetastatic UTUC patients who underwent RNU between 2000 and 2022. Kaplan-Meier survival analysis and Cox proportional hazards regression models were employed to assess the impact of synchronous or metachronous BCa on clinical outcomes.
The cohort included 118 patients (4.0%) with prior non-muscle-invasive BCa (NMIBCa) only and 205 patients (7.1%) with synchronous NMIBCa. Synchronous NMIBCa showed significant associations with inferior overall survival (OS; HR = 1.709, 95% CI: 1.301-2.247) and cancer-specific survival (CSS; HR = 1.577, 95% CI: 1.265-1.967). Multivariate analysis confirmed synchronous NMIBCa as an independent predictor for both OS (HR = 1.709, 95% CI: 1.301-2.247, p < 0.001) and CSS (HR = 1.577, 95% CI: 1.265-1.967, p < 0.001). Neither prior NMIBCa history nor the interval from NMIBCa to UTUC diagnosis showed significant associations with OS or CSS. Of the 2598 patients without prior or synchronous BCa, 491 (18.9%) developed intravesical recurrence after RNU, including 37 (7.5%) cases of muscle-invasive BCa. Among 2598 patients without prior/synchronous BCa, 491 (18.9%) developed intravesical recurrence post-RNU, including 37 (7.5%) muscle-invasive cases. Intravesical recurrence within 1-2 years significantly predicted unfavorable OS and CSS, and muscle-invasive BCa recurrence during this period indicated particularly poor outcomes.
Synchronous NMIBCa is an independent risk factor for worse survival in UTUC patients. Early IVR was significantly related to poor survival outcomes in UTUC patients, particularly in pTa-2 cases. Bladder-directed preventive and adjuvant therapeutic strategies may optimize clinical outcomes.
本研究旨在评估在中国接受根治性肾输尿管切除术（RNU）的上尿路尿路上皮癌（UTUC）患者中，同时性和异时性膀胱癌（BCa）的预后意义。
我们回顾性分析了2000年至2022年间连续接受RNU的2921例非转移性UTUC患者的临床病理数据。采用Kaplan-Meier生存分析和Cox比例风险回归模型来评估同时性或异时性BCa对临床结局的影响。
该队列包括仅患有既往非肌层浸润性膀胱癌（NMIBCa）的118例患者（4.0%）和同时患有NMIBCa的205例患者（7.1%）。同时性NMIBCa与较差的总生存期（OS；HR = 1.709，95%CI：1.301 - 2.247）和癌症特异性生存期（CSS；HR = 1.577，95%CI：1.265 - 1.967）显著相关。多因素分析证实同时性NMIBCa是OS（HR = 1.709，95%CI：1.301 - 2.247，p < 0.001）和CSS（HR = 1.577，95%CI：1.265 - 1.967，p < 0.001）的独立预测因素。既往NMIBCa病史以及从NMIBCa到UTUC诊断的时间间隔均与OS或CSS无显著相关性。在2598例无既往或同时性BCa的患者中，491例（18.9%）在RNU后发生膀胱内复发，其中包括37例（7.5%）肌层浸润性BCa。在2598例无既往/同时性BCa的患者中，491例（18.9%）在RNU后发生膀胱内复发，其中包括37例（7.5%）肌层浸润性病例。1 - 2年内的膀胱内复发显著预示着不良的OS和CSS，在此期间肌层浸润性BCa复发表明预后尤其差。
同时性NMIBCa是UTUC患者生存较差的独立危险因素。早期膀胱内复发与UTUC患者的不良生存结局显著相关，尤其是在pTa - 2病例中。针对膀胱的预防和辅助治疗策略可能会优化临床结局。
