Arrizabalaga Moreno M, Díez Rodríguez J M, García González J I, Esteban Arteaga R, Navarro Sebastián J, Castro Pita M, Mora Durban M, Paniagua Andrés P
Servicio de Urología, Hospital de Móstoles, Madrid, España.
Arch Esp Urol. 1998 Apr;51(3):243-51.
To analyze the survival and the main prognostic factors in patients with transitional cell carcinoma of the upper urinary tract.
From 1983 to 1996, we treated 50 patients with transitional cell carcinoma of the upper urinary tract. Treatment was basically conservative except in those cases whose tumor stage or grade required a radical approach. Grading and staging were performed according to the 1992 TNM classification. Eighteen patients had died at one year mean follow-up., At the time the study was completed (June, 1997), 32 patients were alive with a mean follow-up of 4.9 years. Disease-free survival, overall and specific survival were analyzed according to sex, age, association with bladder tumors, localization, type of treatment, tumor size, number, histological grade and stage.
The male-to-female ratio was 5:1. Patient mean age was 65.7 years. Association with bladder tumors was observed in 50%. Treatment was conservative in 40% and radical in 60%. The five- and ten-year disease-free survival rates were 69%, overall survival 61% and specific survival 71%. The univariate analysis showed the following to be unfavorable prognostic factors for survival: renal vs ureteral tumors, radical vs conservative treatment, high grade and stage tumors. The association of carcinoma in situ with other tumors of the upper urinary tract was also found to be an unfavorable factor for disease-free survival. The multivariate analysis associated T4 and G3 tumors with poor prognosis.
Transitional cell carcinoma of the upper urinary tract was associated with bladder tumors in 50% of the cases. Low grade stage tumors demonstrated a high survival rate, therefore conservative treatment should be the first approach. High grade/ stage tumors were found to be unfavorable prognostic factors for survival.
分析上尿路移行细胞癌患者的生存率及主要预后因素。
1983年至1996年，我们治疗了50例上尿路移行细胞癌患者。除肿瘤分期或分级需要根治性治疗的病例外，治疗基本为保守治疗。根据1992年TNM分类法进行分级和分期。平均随访1年时，18例患者死亡。在研究完成时（1997年6月），32例患者存活，平均随访4.9年。根据性别、年龄、是否合并膀胱肿瘤、肿瘤部位、治疗方式、肿瘤大小、数量、组织学分级和分期分析无病生存率、总生存率和特异性生存率。
男女比例为5:1。患者平均年龄为65.7岁。50%的患者合并膀胱肿瘤。40%的患者接受保守治疗，60%的患者接受根治性治疗。5年和10年无病生存率分别为69%，总生存率为61%，特异性生存率为71%。单因素分析显示，以下因素对生存预后不利：肾肿瘤与输尿管肿瘤、根治性治疗与保守治疗、高分级和高分期肿瘤。原位癌与上尿路其他肿瘤的合并存在也被发现是无病生存的不利因素。多因素分析显示T4和G3肿瘤预后不良。
50%的上尿路移行细胞癌患者合并膀胱肿瘤。低分级低分期肿瘤生存率高，因此保守治疗应作为首选。高分级/高分期肿瘤是生存的不利预后因素。
