上泌尿道腫瘤於腎臟輸尿管及切除膀胱袖口切除後之膀胱復發率:比較鱗狀細胞癌及泌尿上皮細胞癌
黃立華、陳卷書1、歐宴泉1
童綜合醫院 外科部 泌尿科；1台中榮民總醫院 外科部 泌尿外科
Bladder cancer following nephroureterectomy with bladder cuff excision for upper urinart tract malignancy: comparing the incidence between squamous cell carcinoma and urothelial carcinoma
Li-Hua Huang, Chuan-Shu Chen1,Yen-Chuan Ou1
Divisions of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital
2Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
Purpose:
In upper urinary tract (UUT), squamous cell carcinoma(SCC) and urothelial carcinoma (UC) are two different disease in its etiology, incidence and prognosis. Due to paucity of the study in SCC, we treat it just as UC. However, we believe the therapeutic and following protocols for the two diseases are different. In this study, we compare the bladder recurrence rate in these two malignancies.
Materials and Methods:
From January 2000 to December 2007, 327 patients were diagnosed as upper urinary tract malignancy. Their clinical and pathological characteristics were retrospectively reviewed. There were 294 pure UC (90.0%), 24 UC with squamous differentiation (SqD) (7.3%) and 9 pure SCC(2.7%) patient. These patients all received RNU initially. Kaplan-Meier method was used to estimate bladder recurrence free survival (RFS). The recurrence curve is compared by log rank test. The statistical significance was set as p≦0.05.
Results:
The 5-year RFSs of bladder were 67.9%, 70.4 and 100% in UC, UC with SqD and SCC groups respectively. Pairwise comparison was done., and here was no significant difference in bladder RFS between two groups. The p-value of log-rank test comparing UC and SCC is 0.061. Although not statistically significant, there was a trend that patients with UUT-SCC had less bladder recurrence after initially operative management.
Conclusions:
There was a statistical trend that patients with UUT-SCC had less bladder recurrence after initially operative management. It did not reach significance because of the small number of patients with SCC.