Hall M C, Womack J S, Roehrborn C G, Carmody T, Sagalowsky A I
Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA.
J Urol. 1998 Sep;160(3 Pt 1):703-6. doi: 10.1016/S0022-5347(01)62763-0.
We review the outcome of patients with advanced stage III or IV transitional cell carcinoma of the upper urinary tract and the impact of postoperative radiotherapy.
We identified 74 patients who were treated surgically with curative intent for stage III (49) or IV (25) transitional cell carcinoma of the upper urinary tract. Median followup was 21 months (range 1 to 236) for all patients and 60 months (range 29 to 172) for those alive at last contact. A median dose of 40 Gy. adjuvant radiotherapy was delivered to the tumor bed and regional nodes of 15 patients (30%) with stage III and 13 (52%) with stage IV disease.
The actuarial 5-year overall and disease specific survival for patients with stage III disease was 28 and 40%, respectively. Median disease specific survival was 37 months. Median overall and disease specific survival for patients with stage IV disease was 7 months. Isolated local recurrence was identified in 5 of 49 patients with stage III and only 1 of 25 with stage IV disease. The 5-year actuarial disease specific survival rate in patients with stage III disease whether or not they were treated with postoperative radiotherapy was 45 versus 40%, respectively. For patients with stage IV disease median survival was 7 and 9 months for those who were and those who were not treated with postoperative radiotherapy, respectively.
Patients with stages III and IV transitional cell carcinoma of the upper urinary tract have a high risk of disease relapse and cancer mortality. The major clinical feature is distant failure with isolated local relapse uncommon following initial aggressive surgical therapy. There is no survival benefit with postoperative adjuvant radiotherapy. More effective systemic adjuvant therapy is necessary to improve the outcome of these patients.
我们回顾了晚期Ⅲ期或Ⅳ期上尿路移行细胞癌患者的治疗结果以及术后放疗的影响。
我们确定了74例接受手术治疗的上尿路移行细胞癌患者，其中Ⅲ期（49例）或Ⅳ期（25例）患者的手术目的为根治性切除。所有患者的中位随访时间为21个月（范围1至236个月），最后一次随访时仍存活的患者中位随访时间为60个月（范围29至172个月）。15例（30%）Ⅲ期和13例（52%）Ⅳ期疾病患者接受了中位剂量为40 Gy的辅助放疗，照射部位为肿瘤床和区域淋巴结。
Ⅲ期疾病患者的5年总生存率和疾病特异性生存率分别为28%和40%。疾病特异性生存中位数为37个月。Ⅳ期疾病患者的总生存中位数和疾病特异性生存中位数为7个月。49例Ⅲ期患者中有5例出现孤立性局部复发，25例Ⅳ期患者中仅有1例出现孤立性局部复发。Ⅲ期疾病患者无论是否接受术后放疗，5年疾病特异性生存率分别为45%和40%。对于Ⅳ期疾病患者，接受和未接受术后放疗的患者中位生存期分别为7个月和9个月。
Ⅲ期和Ⅳ期上尿路移行细胞癌患者疾病复发和癌症死亡风险较高。主要临床特征是远处转移，初始积极手术治疗后孤立性局部复发不常见。术后辅助放疗无生存获益。需要更有效的全身辅助治疗来改善这些患者的治疗结果。
