非肌层浸润性膀胱癌病史或合并非肌层浸润性膀胱癌对行根治手术的上尿路尿路上皮癌患者预后的影响——上海仁济医院10年资料总结
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摘要
目的:探讨非肌层浸润性膀胱癌(NMIBC)病史或合并NMIBC对行根治手术的上尿路尿路上皮癌(UTUC)患者预后的影响。方法:回顾性分析我院于2006年1月～2015年12月收治的693例UTUC患者的临床及随访资料,分析其临床病理特点及NMIBC病史或合并NMIBC对预后的影响。采用χ2检验分析NMIBC病史或合并NMIBC与各临床病理因素的关系,运用Kaplan-Meier法及log-rank检验进行生存分析,采用Cox比例风险模型进行单因素及多因素分析。结果:87例(12.6%)有NMIBC病史或合并NMIBC,606例(87.4%)无NMIBC病史及未合并NMIBC。随访2～133个月,中位随访时间40个月。随访期间共有216例死亡,其中172例死于UTUC;148例出现膀胱内肿瘤复发。有NMIBC病史或合并NMIBC的患者相较于无NMIBC病史及未合并NMIBC的患者有着更高的多灶性肿瘤(肾盂+输尿管)的比例(P<0.001)及更大的肿瘤直径(P=0.031)。Cox多因素回归分析结果显示NMIBC病史或合并NMIBC、年龄≥65岁、肿瘤WHO高级别、肿瘤≥pT2期及淋巴结转移是总生存率(OS)和肿瘤特异性生存率(CSS)的独立危险因素,而肿瘤直径>3cm是CSS的独立危险因素;NMIBC病史或合并NMIBC、性别及肿瘤位置是膀胱内无复发生存率(IRFS)的独立危险因素(均P<0.05)。结论:有NMIBC病史或合并NMIBC是UTUC患者行根治术后OS、CSS和IRFS的独立危险因素,因此需加强对有NMIBC病史或合并NMIBC的UTUC患者的术后随访。
Objective:To investigate the prognostic significance of previous or synchronous non-muscle invasive bladder cancer(NMIBC)on overall survival(OS),cancer-specific survival(CSS)and intravesical recurrencefree survival(IRFS)for patients with upper tract urothelial carcinoma(UTUC)after radical nephroureterecomy(RNU).Method:A total of 693 consecutive patients treated by RNU in our hospital from January 2006 to December 2015 were retrospectively included.Clinicopathological features,OS,CSS and IRFS were surveyed.Theχ2 test was used to detect the association between previous or synchronous NMIBC and several clinicopathological features.Kaplan-Meier method with the log-rank test was used to assess OS,CSS and IRFS.Multivariate analyses were conducted using Cox proportional-hazards regression model.Result:Median follow-up period was 40(range,2-133)months.Of all 693 patients included,87 patients(12.6%)were previous or synchronous NMIBC and 606 patients(87.4%)were not.During follow-up period,a total of 216 died,and 172 patients died of UTUC.Intravesical recurrence occurred in 148 patients.Patients with previous or synchronous NMIBC had a significantly higher rate of multifocality(P<0.001)and bigger tumor size(P=0.031).Multivariate analysis revealed that previous or synchronous NMIBC,older age,higher tumor grade,advanced tumor stage(≥pT2)and positive lymph node were associated with adverse OS and CSS while tumor size was only an independent predictor of CSS.However,previous or synchronous NMIBC,gender and tumor involving both pelvis and ureter were significantly associated with worse IRFS.Conclusion:Patients with previous or synchronous NMIBC tended to have worse OS,CSS and IRFS.The close follow-up of patients with previous or synchronous NMIBC may be of great importance.
Objective:To investigate the prognostic significance of previous or synchronous non-muscle invasive bladder cancer(NMIBC)on overall survival(OS),cancer-specific survival(CSS)and intravesical recurrencefree survival(IRFS)for patients with upper tract urothelial carcinoma(UTUC)after radical nephroureterecomy(RNU).Method:A total of 693 consecutive patients treated by RNU in our hospital from January 2006 to December 2015 were retrospectively included.Clinicopathological features,OS,CSS and IRFS were surveyed.Theχ2 test was used to detect the association between previous or synchronous NMIBC and several clinicopathological features.Kaplan-Meier method with the log-rank test was used to assess OS,CSS and IRFS.Multivariate analyses were conducted using Cox proportional-hazards regression model.Result:Median follow-up period was 40(range,2-133)months.Of all 693 patients included,87 patients(12.6%)were previous or synchronous NMIBC and 606 patients(87.4%)were not.During follow-up period,a total of 216 died,and 172 patients died of UTUC.Intravesical recurrence occurred in 148 patients.Patients with previous or synchronous NMIBC had a significantly higher rate of multifocality(P<0.001)and bigger tumor size(P=0.031).Multivariate analysis revealed that previous or synchronous NMIBC,older age,higher tumor grade,advanced tumor stage(≥pT2)and positive lymph node were associated with adverse OS and CSS while tumor size was only an independent predictor of CSS.However,previous or synchronous NMIBC,gender and tumor involving both pelvis and ureter were significantly associated with worse IRFS.Conclusion:Patients with previous or synchronous NMIBC tended to have worse OS,CSS and IRFS.The close follow-up of patients with previous or synchronous NMIBC may be of great importance.
引文
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4 Green D A,Rink M,Xylinas E,et al.Urothelial carcinoma of the bladder and the upper tract:disparate twins[J].J Urol,2013,189(4):1214-1221.
5 Chromecki T F,Cha E K,Fajkovic H,et al.The impact of tumor multifocality on outcomes in patients treated with radical nephroureterectomy[J].Eur Urol,2012,61(2):245-253.
6 Xylinas E,Rink M,Margulis V,et al.Multifocal carcinoma in situ of the uppertract is associated with high risk of bladder cancer recurrence[J].Eur Urol,2012,61(5):1069-1070.
7 Ayyathurai R,Soloway M S.Monitoring of the upper urinary tract in patients with bladder cancer[J].Indian JUrol,2011,27(2):238-244.
8 Cosenitino M,Palou J,Gaya J M,et al.Upper urinary tract urothelial cell carcinoma:location as a predictive factor for concomitant bladder carcinoma[J].World JUrol,2013,31(1):141-145.
9 Fang D,Zhang L,Li X,et al.Presence of Concomitant Non-muscle-invasive Bladder Cancer in Chinese Patients with Upper Tract Urothelial Carcinoma:Risk Factors,Characteristics,and Predictive Value[J].Ann Surg Oncol,2015,22(8):2789-2798.
10 Kim B W,Ha Y S,Lee J N,et al.Effects of Previous or Synchronous Non-Muscle Invasive Bladder Cancer on Clinical Results after Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma:A Multi-Institutional Study[J].Urol J,2015,12(4):2233-2239.
11 Nuhn P,Novara G,Seitz C,et al.Prognostic value of prior history of urothelial carcinoma of the bladder in patients with upper urinary tract urothelial carcinoma:results from a retrospective multicenter study[J].World JUrol,2015,33(7):1005-1013.
12 Milojevic B,Djokic M,Sipetic G,et al.Prognostic significance of non-muscle-invasive bladder tumor history in patients with upper urinary tract urothelial carcinoma[J].Urol Oncol,2013,31(8):1615-1620.
13 Simone G,Papalia R,Loreto A,et al.Independent prognostic value of tumour diameter and tumour necrosis in upper urinary tract urothelial carcinoma[J].BJU Int,2009,103(8):1052-1057.
14 Brierley J D,Gospodarowicz M K,Wittekind C.TNMclassification of malignant tumors.UICC International Union Against Cancer[M].8th edn,2017:196-198.
15 Moch H,Humphrey P A,Ulbright T M,et al.WHOClassification of Tumours of the Urinary System and Male Genital Organs[M].4th ed,2016:77-98.
16 周利群,李学松,熊耕砚.中国人群上尿路尿路上皮癌新进展[J].北京大学学报(医学版),2014,46(4):504-506.
17 Shibing Y,Liangren L,Qiang W,et al.Impact of tumour size on prognosis of upper urinary tract urothelial carcinoma after radical nephroureterectomy:a multi-institutional analysis of 795cases[J].BJU Int,2016,118(6):902-910.
2 Siegel R,Naishadham D,Jemal A.Cancer statistics,2012[J].CA Cancer J Clin,2012,62(1):10-29.
3 Catto J W,Yates D R,Rehman I,et al.Behavior of urothelial carcinoma with respect to anatomical location[J].J Urol,2007,177(5):1715-1720.
4 Green D A,Rink M,Xylinas E,et al.Urothelial carcinoma of the bladder and the upper tract:disparate twins[J].J Urol,2013,189(4):1214-1221.
5 Chromecki T F,Cha E K,Fajkovic H,et al.The impact of tumor multifocality on outcomes in patients treated with radical nephroureterectomy[J].Eur Urol,2012,61(2):245-253.
6 Xylinas E,Rink M,Margulis V,et al.Multifocal carcinoma in situ of the uppertract is associated with high risk of bladder cancer recurrence[J].Eur Urol,2012,61(5):1069-1070.
7 Ayyathurai R,Soloway M S.Monitoring of the upper urinary tract in patients with bladder cancer[J].Indian JUrol,2011,27(2):238-244.
8 Cosenitino M,Palou J,Gaya J M,et al.Upper urinary tract urothelial cell carcinoma:location as a predictive factor for concomitant bladder carcinoma[J].World JUrol,2013,31(1):141-145.
9 Fang D,Zhang L,Li X,et al.Presence of Concomitant Non-muscle-invasive Bladder Cancer in Chinese Patients with Upper Tract Urothelial Carcinoma:Risk Factors,Characteristics,and Predictive Value[J].Ann Surg Oncol,2015,22(8):2789-2798.
10 Kim B W,Ha Y S,Lee J N,et al.Effects of Previous or Synchronous Non-Muscle Invasive Bladder Cancer on Clinical Results after Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma:A Multi-Institutional Study[J].Urol J,2015,12(4):2233-2239.
11 Nuhn P,Novara G,Seitz C,et al.Prognostic value of prior history of urothelial carcinoma of the bladder in patients with upper urinary tract urothelial carcinoma:results from a retrospective multicenter study[J].World JUrol,2015,33(7):1005-1013.
12 Milojevic B,Djokic M,Sipetic G,et al.Prognostic significance of non-muscle-invasive bladder tumor history in patients with upper urinary tract urothelial carcinoma[J].Urol Oncol,2013,31(8):1615-1620.
13 Simone G,Papalia R,Loreto A,et al.Independent prognostic value of tumour diameter and tumour necrosis in upper urinary tract urothelial carcinoma[J].BJU Int,2009,103(8):1052-1057.
14 Brierley J D,Gospodarowicz M K,Wittekind C.TNMclassification of malignant tumors.UICC International Union Against Cancer[M].8th edn,2017:196-198.
15 Moch H,Humphrey P A,Ulbright T M,et al.WHOClassification of Tumours of the Urinary System and Male Genital Organs[M].4th ed,2016:77-98.
16 周利群,李学松,熊耕砚.中国人群上尿路尿路上皮癌新进展[J].北京大学学报(医学版),2014,46(4):504-506.
17 Shibing Y,Liangren L,Qiang W,et al.Impact of tumour size on prognosis of upper urinary tract urothelial carcinoma after radical nephroureterectomy:a multi-institutional analysis of 795cases[J].BJU Int,2016,118(6):902-910.