腫瘤位置對 pT3N0M0 上泌尿道尿路上皮癌預後的影響
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.