- 作者：Jeffery C. Wheat ; M.D.a ; jefwheat@med.umich.edu ; Alon Z. Weizer ; M.D.a ; J. Stuart Wolf Jr. ; M.D.a ; Yair Lotan ; M.D.b ; Mesut Remzi ; M.D.c ; Vitaly Margulis ; M.D.d ; Christopher G. Wood ; M.D.d ; Francesco Montorsi ; M.D.e ; Marco Roscigno ; M.D.e ; Eiji Kikuchi ; M.D.f ; Richard Zigeuner ; M.D.g ; Cord Langner ; M.D.g ; Christian Bolenz ; M.D.h ; Theresa M. Koppie ; M.D.i ; Jay D. Raman ; M.D.j ; Mario Ferná ; ndez ; M.D.k ; Pierre Karakiewizc ; M.D.l ; Umberto Capitanio ; M.D.l ; Karim Bensalah ; M.D.m ; Jean-Jacques Patard ; M.D.m ; Shahrokh F. Shariat ; M.D.n
- 关键词：Transitional cell carcinoma ; Nephroureterectomy ; Carcinoma in situ ; Upper tract
- 刊名：Urologic Oncology ; Seminars and Original Investigations
- 出版年：2012
- 期刊代码：266_10781439
- 类别：med
- 出版时间：May-June, 2012
- 卷：30
- 期：3
- 页码：252-258
- 文件大小：571 K
Objective
Carcinoma in situ (CIS) is associated with increased risk of progression when found with high-grade non-muscle-invasive bladder cancer, yet its impact is less clear in the upper urinary tract. In the current study, we evaluated the impact of concomitant CIS on recurrence-free survival and cancer-specific survival following radical nephroureterectomy for upper tract urothelial carcinoma (UTUC).Materials and methods
A multi-institutional retrospective cohort of 1,387 patients undergoing radical nephroureterectomy was identified. Concomitant CIS was defined as the presence of CIS in association with another pathologic stage; patients with CIS alone were excluded from the analysis. The presence of concomitant CIS served as the exposure variable with disease recurrence and cancer-specific mortality as the outcomes. Organ-confined disease was defined as AJCC/UICC stage II or lower.
Results
Concomitant CIS was identified in 371 of 1,387 (26.7%) patients and was significantly more common in patients with a previous bladder cancer history, high grade, and high stage tumors. In a multivariable analysis, concomitant CIS was a predictor of disease recurrence (HR = 1.25, P = 0.04) and cancer specific mortality (HR = 1.34, P = 0.05) for patients with organ-confined UTUC, but not in the entire cohort. Other prognostic variables, such as grade, stage, lymphovascular invasion, and lymph node status, were associated with poorer overall and recurrence-free survival for all patients.
Conclusion
The presence of concomitant CIS in patients with organ-confined UTUC is associated with a higher risk of recurrent disease and cancer-specific mortality. This information may be useful in refining surveillance protocols and in more appropriate selection of patients for adjuvant chemotherapy.