Hall M C, Womack S, Sagalowsky A I, Carmody T, Erickstad M D, Roehrborn C G
Department of Urology, The University of Texas Southwestern Medical Center, Dallas 75235-9110, USA.
Urology. 1998 Oct;52(4):594-601. doi: 10.1016/s0090-4295(98)00295-7.
To review a large single-center experience of patients treated for upper tract transitional cell carcinoma (TCC) with extended follow-up in order to identify patterns of recurrence, assess patient outcomes, and determine the impact of traditional prognostic factors.
We reviewed 252 patients treated surgically for upper tract TCC with a median follow-up of 64 months. Most patients (77%) underwent nephroureterectomy, whereas 17% were treated with a parenchymal sparing approach. Traditional prognostic factors including age, sex, tumor stage, grade, location, and type of surgical treatment were analyzed with respect to disease recurrence and survival.
Disease relapse occurred in 67 patients (27%) at a median time of 12.0 months. Recurrences were local in the retroperitoneum (9%), the bladder (51%), remaining upper tract (18%), or distant in the lung, bone, or liver (22%). The 6 patients with local relapse were among the 73 patients with pT3 or pT4 tumors, and all died of TCC at a median time from diagnosis of 37 months. Significant prognostic factors for recurrence by univariate analysis were tumor grade (P = 0.0014) and stage (P = 0.0001). On multivariate analysis, only tumor stage (P = 0.017) and treatment modality (P = 0.020) were predictors of recurrence. Actuarial 5-year disease-specific survival rates by primary tumor stage were 100% for Ta/cis, 91.7% for T1, 72.6% for T2, and 40.5% for T3. Patients with primary Stage T4 tumors had a median survival of 6 months. Although tumor stage and grade correlated with disease-specific survival on univariate analysis, only patient age (P = 0.042) and stage (P = 0.0001) were significant on multivariate analysis with the type of surgical procedure performed approaching significance (P = 0.0504).
Primary tumor stage and surgical procedure performed (radical versus parenchymal sparing) are important predictors of disease recurrence. Patient age and tumor stage were the only predictors of disease-specific survival on multivariate analysis with the type of surgical procedure approaching significance. Radical nephroureterectomy achieves excellent local control even in the setting of locally advanced (pT3 or T4) disease. The major clinical feature in this setting is distant failure, and the development of effective systemic therapy is needed to improve the outcome in these patients.
回顾在一个大型单中心接受上尿路移行细胞癌（TCC）治疗且随访时间延长的患者的情况，以确定复发模式、评估患者预后，并确定传统预后因素的影响。
我们回顾了252例接受上尿路TCC手术治疗的患者，中位随访时间为64个月。大多数患者（77%）接受了肾输尿管切除术，而17%采用了保留肾实质的方法。分析了包括年龄、性别、肿瘤分期、分级、位置和手术治疗类型等传统预后因素与疾病复发和生存的关系。
67例患者（27%）出现疾病复发，中位复发时间为12.0个月。复发部位为腹膜后局部（9%）、膀胱（51%）、剩余上尿路（18%）或远处肺、骨或肝（22%）。6例局部复发患者在73例pT3或pT4肿瘤患者中，所有患者均死于TCC，从诊断到死亡的中位时间为37个月。单因素分析中复发的显著预后因素为肿瘤分级（P = 0.0014）和分期（P = 0.0001）。多因素分析中，只有肿瘤分期（P = 0.017）和治疗方式（P = 0.020）是复发的预测因素。根据原发肿瘤分期，Ta/cis期患者的5年疾病特异性生存率为100%，T1期为91.7%，T2期为72.6%，T3期为40.5%。原发T4期肿瘤患者的中位生存期为6个月。虽然在单因素分析中肿瘤分期和分级与疾病特异性生存相关，但在多因素分析中，只有患者年龄（P = 0.042）和分期（P = 0.0001）具有显著性，手术方式的类型接近显著性（P = 0.0504）。
原发肿瘤分期和所施行的手术方式（根治性与保留肾实质）是疾病复发的重要预测因素。在多因素分析中，患者年龄和肿瘤分期是疾病特异性生存的唯一预测因素，手术方式的类型接近显著性。根治性肾输尿管切除术即使在局部晚期（pT3或T4）疾病的情况下也能实现良好的局部控制。这种情况下的主要临床特征是远处转移，需要开发有效的全身治疗方法来改善这些患者的预后。
