腫瘤位置對 pT3N0M0 上泌尿道尿路上皮癌預後的影響

陳子双¹、陳彥達¹、王弘仁¹、江博暉²、楊文洲¹、李維菁¹、莊燿吉¹、鄭元佐¹、康智雄¹、
李偉嘉¹、陳建旭¹、沈元琦¹、柳易揚¹、劉惠瑛¹、張殷綸¹、蘇祐立³、黃俊杰⁴、羅浩倫¹

¹高雄長庚紀念醫院 泌尿科 ; ²忠孝泌尿醫院 ; ³高雄長庚紀念醫院 血液腫瘤科 ; ⁴高雄長庚紀念醫院 放射腫瘤科

The Prognostic Impact of Tumor Location in pT3N0M0 Upper Urinary Tract Urothelial Carcinoma

Tzu Shuang Chen¹, Yen Ta Chen¹, Hung Jen Wang¹, Po Hui Chiang², Wen Chou Yang¹, Wei Ching Lee¹, Yao Chi Chuang¹, Yuan Tso Cheng¹, Chih Hsiung Kang¹, Wei Chia Lee¹, Chien Hsu Chen¹, Yuan Chi Shen¹, Yi Yang Liu¹, Hui Ying Liu¹, Yin Lun Chang¹, Yu Li Su³, Chun Chieh Huang⁴, Hao Lun Luo¹

¹Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

²Jhong Siao Urological Hospital, Kaohsiung, Taiwan

³Department of Hematology and Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

⁴Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Purpose: We aimed to evaluate the impact of tumor location on cancer outcomes in patients with pT3N0M0 upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU) with bladder cuff excision.

Materials and Methods: We retrospectively reviewed 302 patients with pT3N0M0 UTUC who underwent RNU with bladder cuff excision at our institution between 2005 and 2019, including 191 renal pelvis tumors and 111 ureteral tumors. Clinicopathologic characteristics were compared between renal pelvis and ureter urothelial carcinomas. Multivariate Cox proportional hazard regression was used to assess the association between outcomes and clinical factors. Outcomes of interest included intravesical recurrence-free survival (IVRFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS), which were measured using the Kaplan–Meier curve with a log-rank test.

Results: A total of 302 patients underwent RNU with bladder cuff excision. During the median follow-up of 42.7 months, 70 (23.2%), 95 (31.5%), and 99 (32.8%) patients experienced intravesical recurrence, local recurrence, and distant metastasis, respectively. Seventy (23.2%) patients died from UTUC. Multivariate Cox regression analysis showed that tumor location was an independent predictor of local recurrence (HR = 2.05, p = 0.001), with borderline independent significance in intravesical recurrence (HR = 1.54, p = 0.074) and distant metastasis (HR = 1.45, p = 0.08). Kaplan–Meier analysis showed that ureter tumors had a worse 5-year local recurrence (log-rank p < 0.001) and borderline worse 5-year intravesical recurrence (log-rank p = 0.055) and 5-year distant metastasis (log-rank p = 0.073).

Conclusions: Ureter tumors seem to be associated with worse oncological outcomes, especially with local recurrence in UTUC. Further large and long-term studies are warranted for investigating biological differences based on tumor location.