接受根除性腎臟輸尿管切除術上泌尿道尿路上皮癌的病人，變異組織型對於癌症預後的影響

于宗玉、王弘仁、李維菁、莊燿吉、陳彥達、鄭元佐、康智雄、李偉嘉、陳建旭、沈元琦、柳易揚、劉惠瑛、張殷綸、楊文洲、江博暉、羅浩倫

高雄長庚紀念醫院泌尿科

Effects of Variant Histology on the Oncology Outcomes of Patients with Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy

YU TSUNG, YU, Hung-Jen Wang , Wei-Ching Lee, Yao-Chi Chuang, Yen-Ta Chen, Yuan-Tso Cheng, Chih-Hsiung Kang, Wei-Chia Lee, Chien-Hsu Chen, Yuan-Chi Shen, Yi Yang Liu, Hui Ying Liu, Yin Lun Chang, Wen-Chou Yang, Po-Hui Chiang, Hao-Lun Luo

Kaohsiung Chang Gung Memorial Hospital, Department of Urology

Purpose: To investigate the prognostic effects of variant histology(VH) on survival outcomes after radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma(UTUC)

Materials and methods: This study included total of 1239 patients with clinical localized UTUC who underwent radical nephroureterectomy (RNU) at our institution between January 2005 and June 2020 and excluded patients who underwent nephron-sparing surgery and those with non-urothelial carcinoma histology. The Kaplan–Meier method with log-rank test was used to compare event-free survival between the groups. Multivariate Cox regression analysis was used to identify independent prognostic factors upon oncologic outcome.

Result: Of all 1239 upper urinary tract tumor patients, UTUC with VH was observed in 384 patients(31%). UTUC with VH was significantly associated with advanced tumor stage, lymph node metastasis, high tumor grade, lymphovascular invasion compared with pure UTUC (all P < 0.001). Multivariate analysis revealed that VH was a borderline independent prognostic factor for intravesical recurrence (HR= 0.78; 95% CI:0.6-1; P = 0.054), independent predictor for metastasis (HR= 1.31; 95% CI:1.03–1.66; P = 0.025), and borderline independent predictor for cancer-specific mortality (HR= 1.31; 95% CI:1–1.71; P =0.051).

Conclusion: We found that about one third of patients with UTUC treated with RNU had variant histology in this cohort. UTUC with VH was associated with more metastasis and cancer-specific mortality but less intravesical recurrence.