- 作者：G茅raldine Pignot ; Pierre Colin ; Marc Zerbib ; Fran莽ois Audenet ; Michel Souli茅 ; Sophie Hurel ; Francky Delage ; Jacques Irani ; Aur茅lien Descazeaud ; St茅phane Droupy ; Fran莽ois Rozet ; V茅ronique Ph茅 ; Alain Ruffion ; Jean-Alex ; re Long ; Sebastien Crouzet ; Alain Houlgatte ; Pierre Bigot ; Laurent Guy ; Pierre-Olivier Fa茂s ; Morgan Roupr锚t ; et al.
- 关键词：Upper urinary tract ; Urothelial carcinoma ; Bladder cancer ; Recurrence ; Survival ; Prognostic factor
- 刊名：Urologic Oncology: Seminars and Original Investigations
- 出版年：January, 2014
- 年：2014
- 卷：32
- 期：1
- 页码：23.e1-23.e8
- 全文大小：342 K
Objective
The objective of the study was to evaluate the effect of a history of bladder cancer (BC) or synchronous BC on the prognosis and survival of patients who have undergone radical nephroureterectomy (RNU).Methods and materials
Using a multi-institutional, retrospective database, we identified 662 patients with upper urinary tract urothelial carcinoma (UUT-UC) treated by radical nephroureterectomy, between 1995 and 2010. We analyzed clinicopathologic characteristics and outcomes according to the history of BC or concomitant BC or both, at the time of diagnosis. BC was evaluated as a prognostic factor for bladder recurrence and survival.
Results
Overall, 83 (12.5%) patients had previous BC, 62 (9.4%) exhibited concomitant BC, and 75 (11.3%) presented with both previous and current BC. A history of BC was less seen in women and nonsmokers (P<0.0001 and P = 0.013, respectively). The patients with associated BC had more tumors located in the ureter (P<0.0001), as well as more multiple locations in the upper tract (P<0.0001). The tumors without concomitant BC were more likely to be associated with locally advanced stages (P = 0.024). At a median follow-up time of 37.3 months, 31.4% of patients experienced BC recurrence and 2.9% developed contralateral upper tract tumor. Using multivariate analyses, the previous or synchronous BC (P = 0.01) and positive surgical margins (P = 0.03) are independent prognostic factors for BC recurrence. The metastasis-free survival and cancer-specific survival rates did not significantly differ according to the associated BC status.
Conclusions
In patients without previous or concomitant BC, the upper tract tumors are more frequently localized in the renal pelvis and are associated with a more invasive status at the time of diagnosis. Nevertheless, the presence of UUT-UC without previous or synchronous BC did not significantly affect the survival rates after nephroureterectomy.