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.

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    台灣泌尿科醫學會
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    2022-06-07 12:22:37
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