台灣與日本上泌尿道尿路上皮癌臨床特徵與腫瘤預後分析
羅浩倫1，畠山 真吾2，江博暉1，大山 力，王弘仁1，楊文洲1，莊燿吉1，陳彥達1，李維菁1，鄭元佐1
1.高雄長庚紀念醫院泌尿科, 2.弘前大學附設醫院泌尿科
Characteristics and oncologic outcome of upper urinary tract urothelial carcinoma between Taiwan and Japan
Luo Hao Lun1，Shingo Hatakeyama2，Chiang Po Hui1，Chikara Ohyama，Wang Hung Jen1，Yang Wen Chou1，Chuang Yao Chi1，Chen Yen Ta1，Lee Wei Ching1，Cheng Yuan Tso1
1.Department of Urology, Kaohsiung Chang Gung Memorial Hospital, 2.Department of urology, Hirosaki University Hospital
Purpose:
The incidence of upper urinary tract urothelial carcinoma (UTUC) is much higher in Taiwan than that of Japan. In addition, female predominance was reported in Taiwanese population. The gender distribution of UTUC in Japan is like UTUC in most country such as America, Europe and Korea (male predominance). There is no direct comparison about UTUC characteristics and cancer behavior between these two distinguished population group.
Materials and Methods:
In this study, there are two cohorts of tertiary referral center included in this study. The Taiwan UTUC cohort (828 patients) is obtained from Kaohsiung Chang Gung Memorial Hospital (From 2005 to 2015) and the Japan UTUC cohorts (456 patients) is obtained from Hirosaki University Hospital (From 2010 to 2017). The inclusion criteria are upper urinary tract urothelial carcinoma underwent radical nephroureterectomy. The patients received neoadjuvant and adjuvant chemotherapy were excluded. Finally, there are 765 patients in Taiwan cohort and 325 patients in Japan cohort were analyzed. The end point of this study is to observe the natural course of UTUC within five years between these two groups.
Results:
The primary result revealed the UTUC is younger (p<0.001), more female (p<0.001), more low stage disease (p<0.001), more chronic kidney disease (p<0.001), less smoking population (p<0.001), more bladder cancer history (p=0.002), more multifocal disease (p<0.001), less high grade disease (p=0.015), less lymphovascular invasion (p<0.001), and more squamous differentiation (p<0.001) in Taiwan. However, the multivariate cox regression analysis showed no difference between these two population in oncologic outcome such as intravesical recurrence, systemic recurrence, or cancer specific death.
Conclusion:
The clinical characteristics of UTUC in Taiwan is significantly different to UTUC in Japan. However, there is no significant difference in oncologic outcome after standard nephroureterectomy.