泌尿上皮癌淋巴血管侵犯是一個與特定腫瘤分期相關的術後的復發危險因子
陳柏諺、羅浩倫、江博暉
高雄長庚紀念醫院 泌尿科
Lymphovascular invasion is a stage-specific risk factor for systemic recurrence after nephroureterectomy in patients with upper tract urothelial carcinoma
Po Yen Chen, Hao Lun Luo, Po Hui Chiang
Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Purpose: To clarify the oncological outcomes of lymphovascular invasion (LVI) in different clinical stages in patients with upper tract urothelial carcinoma (UTUC) after nephroureterectomy.
Materials and Methods: We retrospectively reviewed patients who underwent nephroureterectomy for UTUC from 2005 to 2013 without adjuvant or neoadjuvant chemotherapy. The perioperative parameters included age, gender, smoking, clinical stage, pathological grade, tumor location, pathological features and systematic recurrence. The parameters were analyzed in Cox proportional hazards regression and Kaplan-Meier analysis. Organ-confined disease was defined as AJCC/UICC stage II or lower.
Results: A total of 730 patients received nephroureterectomy for UTUC median follow up 44.8 months in the cohort, there were 153 (21.0%) showed LVI in the pathology report. The primary end point in this study is systemic disease recurrence after surgical intervention. Multivariate Cox regression analysis showed stage, smoking, and LVI were significant risk factors for systemic recurrence. Kaplan-Meier analysis revealed there were no significant difference regarding to systemic recurrence in organ confined UTUC according to the presence of lymphovascular invasion (p=0.230). By contrast, lymphovascular invasion is independently associated with systemic disease recurrence in non-organ confined UTUC (p=0.009).
Conclusion: Lymphovascular invasion is a stage-specific risk factor for systemic recurrence for UTUC patients after nephroureterectomy. Non-organ confined disease with LVI indicates poor prognosis and it might be an important indicator for early adjuvant chemotherapy intervention.