上泌尿道尿路上皮癌的不同表現-台灣日本上泌尿道尿路上皮癌族群比較
劉昱良1、羅浩倫1、Shingo Hatakeyama2、王弘仁1、Tohru Yoneyama2、
楊文洲1、莊耀吉1、陳彥達1、李維菁1、鄭元佐1、康智雄1、Chikara Ohyama2、江博暉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
Unusual presentation of upper urinary tract urothelial carcinoma in Taiwan, direct comparison from Taiwan-Japan UTUC collaboration cohort.
Yu Liang Liu1, Hao Lun Luo1, Shingo Hatakeyama2, Hung Jen Wang1,
Tohru Yoneyama2, Wen Chou Yang1, Yao Chi Chuang1, Yen Ta Chen1, Wei Chin Lee1, Yuan Tso Cheng1, Chih Hsiung Kang1, Chikara Ohyama2, Po Hui Chiang1
Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan1
Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan2
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.