泌尿上皮癌患者在腎臟輸尿管及膀胱袖口切除術後發生膀胱內腫瘤復發之預測因子

陳震亞¹、吳文正^1,3,5、葉信志^1,3,4,5、柯宏龍^1,2,3,5、李威明^1,2,6、李香瑩^1,2,3

¹高雄醫學大學附設醫院泌尿部²高雄醫學大學臨床醫學研究所³高雄市立大同醫院⁴高雄醫學大學醫學研究所⁵高雄醫學大學醫學系泌尿醫學科⁶衛生福利部屏東醫院

Predictive Factors of Intravesical Recurrence after Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

Chen-Ya Chen¹, Wen‐Jeng Wu^1,3,5,Hsin‐Chih Yeh^1,3,4,5, Hung-Lung Ke^1,2,3,5,Wei-Ming Li^1,2,6, Hsiang-Ying Lee^1,2,3

¹Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan ²Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ³Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan⁴Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan⁵Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ⁶Pingtung Hospital, Department of Health, Executive Yuan, Pingtung, Taiwan

Purpose: To evaluate predictor factors of increasing intravesical recurrence rate in patients with upper tract urothelial carcinoma (UTUC) after receiving radical nephroureterectomy (RNUx) with bladder cuff excision (BCE).

Materials and Methods: A total of 2,114 patients were divided into two groups: Intravesical recurrence (IVR)-free and IVR after RNUx, with 1,527 and 587 patients, respectively. To determine the factors affecting IVR, TNM stage, the usage of preoperative ureteroscopy, and pathological outcomes were evaluated. The Kaplan-Meier estimator was used to estimate the rates of prognostic outcomes in overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS), and the survival curves were compared using the stratified log-rank test.

Results: Based on our research, ureter tumor, female, smoking history, old age (>70 years old), multifocal tumor, history of bladder cancer were determined to increase the risk of IVR after univariate analysis. The multivariable analysis revealed female (BRFS for male: HR 0.566, 95% CI 0.469-0.681, p<0.001), ureter tumor (BRFS: HR 1.359, 95% CI 1.133-1.631, p=0.001), multifocal (BRFS: HR 1.200, 95% CI 1.001-1.439, p=0.049), history of bladder cancer (BRFS: HR 1.480, 95% CI 1.118-1.959, p=0.006) were the prognostic factor for IVR. Patients who ever received ureterorenoscopic biopsy did not increase the risk of IVR.  

Conclusion: Patients with ureter tumor and previous bladder UC history are important factors to increase the risk of IVR after radical nephroureterctomy. More frequent follow-up regimen may be needed for these patients.