糖尿病及輸尿管之上泌尿道上皮癌將增加腎臟輸尿管切除術後病人膀胱癌風險
胡哲源1、蔡育傑2、王碩盟1、黃昭淵1、戴槐青1、陳忠信1、蒲永孝1、林維洲3、黃國皓1
1台大醫院泌尿部，2台大醫院腫瘤醫學部，3台大醫院病理部
Ureteral Involvement and Diabetes Increase the Risk of Subsequent Bladder Recurrence after Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma
Che-Yuan Hu1, Yu-Chieh Tsai2, Shuo-Meng Wang1, Chao-Yaun Huang1, Huai-Ching Tai1, Chung-Hsin Chen1, Yeong-Shiau Pu1, Wei-Chou Lin3 and Kuo-How Huang1
1Department of Urology, 2Department of Oncology and 3Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
Purpose:
To investigate the prognostic factors for bladder recurrence after radical nephroureterectomy (RNU) in patients with upper urinary tract urothelial carcinoma (UUT-UC)
Materials and Methods:
From 1994 to 2012, 695 patients with UUT-UC treated with RNU were enrolled in National Taiwan University Medical Center. Among them, 532 patients with no prior bladder UC histories were recruited for analysis. We assessed the impact of potentially prognostic factors on bladder recurrence after RNU.
Results:
The median follow-up period was 47.8 months. In the Cox model, ureteral involvement and diabetes mellitus (DM) were significantly associated with a higher bladder recurrence rate in the multivariate analysis (hazard ratio [HR]: 1.838; p=0.003 and HR: 1.821; p=0.010, respectively). In the Kaplan-Meier analysis, DM patients with concomitant ureteral UC experienced about a three-fold increased risk of bladder recurrence as compared to those without both factors (HR: 3.222; p< 0.001). Patients with either one of the two risk factors experienced about a two-fold increased risk as compared to those without both factors (with DM, HR: 2.184, p= 0.024; with ureteral involvement, HR: 2.006, p= 0.003).
Conclusion:
Ureteral involvement and DM are significantly related to bladder recurrence after RNU in patients with UUT-UC.