建立及驗證局部上泌尿道泌尿上皮癌患者在手術後早期復發的預測模型

張嘉論、周奕儒、蔡曜州

台北慈濟醫院泌尿科

Development and Validation of Early Recurrence Predicting Model in Patients with Localized Upper Tract Urothelial Carcinoma Treated by Radical Nephroureterectomy

Chia-Lun Chang, Yi-Ju Chou, Yao-Chou Tsai

Division of Urology, Taipei Tzu Chi Hospital

Purpose:

Most cases of upper tract urothelial carcinoma (UTUC) exhibit recurrence within the first year following surgery. The time from surgery to recurrence significantly impacts cancer-specific survival. In this study, we analyzed patients with localized UTUC (pTis–3N0/xcM0) who experienced postoperative recurrence to identify an appropriate early recurrence time point and the associated risk factors.

Materials and Methods:

From July 1988 to October 2022, we retrospectively analyzed 805 localized UTUC patients with recurrence after undergoing radical nephroureterectomy using Taiwan's UTUC Collaboration Group Database. Early recurrence time point was defined according to oncologic outcome. Variables including clinical and pathological characteristics were assessed in relation to early recurrence. A prediction model was constructed by factors associated with early recurrence and was externally validated.

Results:

Early recurrence time point in localized UTUC was determined at 9 months post-surgery. Patients with early recurrence had inferior overall and cancer specific survival compared to late recurrence group. Age, performance status, lympho-vascular invasion, and higher pathologic T stage were independent factors associated with early recurrence. The predictive model for early recurrence achieved an area under the curve of 0.69. External validation demonstrated that the model exhibited good discrimination, calibration, and clinical utility in a distinct cohort.

Conclusion:

We found the optimal time point for early recurrence and the associated risk factors. A prediction model for early recurrence was developed and validated. Future research should explore more effective strategies for early recurrence prevention.