泌尿上皮類肉瘤癌在膀胱與上泌尿道之比較：單一醫學中心經驗與文獻回顧

謝佳駤¹、曾文歆^1,2、黃冠華¹、邱文祥³

台南永康奇美醫院 外科部 泌尿科¹；國立中山大學生物醫學研究所²；台北新光吳火獅紀念醫院 泌尿科³

Comparison of Sarcomatoid Urothelial Carcinoma in Urinary Bladder and Upper Urinary Tract: A Single-center Experience and Literature Review

Chia-Chih Hsieh¹、Wen-Hsin Tseng^1,2、Steven K. Huang¹、Allen W.Chiu³

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

² Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan;

³ Division of Urology, Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

Purpose: Sarcomatoid urothelial carcinoma (UC), a rare malignant neoplasm characterized by combination of epithelial and mesenchymal differentiation, constitutes a mere 0.3% of all UC cases. Its occurrence in the renal pelvis is even scarcer, with fewer than 30 reported cases to date. The scarcity of data and consensus on treatment strategies underscores the urgency of addressing this disease. This study seeks to compare the prognosis in sarcomatoid UC between the urinary bladder and upper urinary tract.

Materials and Methods: In this single-center study, we evaluated 35 sarcomatoid urothelial carcinoma (UC) patients. One patient with urinary bladder sarcomatoid UC was lost to follow-up. The remaining patients were categorized into two groups: sarcomatoid urinary bladder UC (SUBUC) (Group 1) and sarcomatoid upper urinary tract UC (SUTUC) (Group 2), and their outcomes were analyzed.

Results: In total, 17 (50%) patients in Group 1 with SUBUC and 17 (50%) in Group 2 with SUTUC. There was no significant different of patient characteristics, including sex, DM, HTN, and Charlson comorbidity index score. However, mean diagnostic age was significant younger in SUTUC than SUBUC (66.53-year-old vs. 76.41-year-old, p=0.005). All patient of SUTUC received nephroureterectomy and only 3 patients of SUBUC received radical cystectomy. Recurrence rate was significantly higher in SUTUC group (52.9% vs. 88.2%, p=0.024). But among those who had cancer recurrence, it is significantly shorter of SUBUC’s recurrence (SUBUC 4 months vs. SUTUC 8.87 months, p=0.024). Mean follow up time for these two groups had no difference (SUBUC 15.76 months vs. SUTUC 15.35 months, p=0.941) and both groups had high mortality rate (SUBUC 76.47% vs. SUTUC 94.1, p=0.146).

Conclusions: This study compared the outcomes of SUBUC and SUTUC post-treatment. Both exhibited high mortality and recurrence rates. Existing literature supports the inferior survival of sarcomatoid UC. However, due to the absence of a standard treatment protocol, rigorous multi-institutional research is needed.