■我们旨在评估术前局部症状对上尿路尿路上皮癌(UTUC)患者根治性肾输尿管切除术后预后的影响。
■这项回顾性研究包括1988年至2019年在台湾15个机构接受治疗的2,662例UTUC患者。临床病理资料由台湾UTUC协作组进行回顾性分析。采用Kaplan-Meier法计算总生存期(OS),癌症特异性生存率(CSS),无病生存率(DFS),和膀胱无复发生存率(BRFS)。术前局部症状对OS、CSS,DFS,BRFS采用Cox比例风险模型进行研究。
■中位随访时间为36.6个月。在2662名患者中,诊断时2,130(80.0%)出现血尿,398(15.0%)出现症状性肾积水。血尿与症状性较轻的肾积水相关(p<0.001),更多的透析状态(p=0.027),肾盂肿瘤(p<0.001),和早期病理肿瘤分期(p=0.001)。症状性肾积水与女性患者相关(p<0.001),透析状态较低(p=0.001),膀胱癌病史较少(p<0.001),输尿管肿瘤(p<0.001),开放手术(p=0.006),晚期病理肿瘤分期(p<0.001),术后化疗(p=0.029)。Kaplan-Meier分析显示血尿或无症状性肾积水患者的OS率明显增高,CSS,和DFS(所有p<0.001)。多因素分析证实,血尿的存在与更好的OS(HR0.789,95%CI0.661-0.942)和CSS(HR0.772,95%CI0.607-0.980)独立相关,而症状性肾积水是OS较差的重要预后因素(HR1.387,95%CI1.142-1.683),CSS(HR1.587,95%CI1.229-2.050),和DFS(HR1.378,95%CI1.122-1.693)。
■术前局部症状与肿瘤预后显著相关,而症状性肾积水和血尿具有相反的预后效果。术前症状可能为UTUC患者的风险分层和围手术期治疗选择提供更多信息。
UNASSIGNED: We aimed to evaluate the impact of preoperative local symptoms on prognosis after radical nephroureterectomy in patients with upper tract urothelial carcinoma (UTUC).
UNASSIGNED: This retrospective study consisted of 2,662 UTUC patients treated at 15 institutions in Taiwan from 1988 to 2019. Clinicopathological data were retrospectively collected for analysis by the Taiwan UTUC Collaboration Group. The Kaplan-Meier method was used to calculate overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS). The prognostic value of preoperative local symptoms in OS, CSS, DFS, and BRFS was investigated using Cox proportional hazards models.
UNASSIGNED: The median follow-up was 36.6 months. Among 2,662 patients, 2,130 (80.0%) presented with hematuria and 398 (15.0%) had symptomatic hydronephrosis at diagnosis. Hematuria was associated with less symptomatic hydronephrosis (p <0.001), more dialysis status (p = 0.027), renal pelvic tumors (p <0.001), and early pathological tumor stage (p = 0.001). Symptomatic hydronephrosis was associated with female patients (p <0.001), less dialysis status (p = 0.001), less bladder cancer history (p <0.001), ureteral tumors (p <0.001), open surgery (p = 0.006), advanced pathological tumor stage (p <0.001), and postoperative chemotherapy (p = 0.029). Kaplan-Meier analysis showed that patients with hematuria or without symptomatic hydronephrosis had significantly higher rates of OS, CSS, and DFS (all p <0.001). Multivariate analysis confirmed that presence of hematuria was independently associated with better OS (HR 0.789, 95% CI 0.661-0.942) and CSS (HR 0.772, 95% CI 0.607-0.980), while symptomatic hydronephrosis was a significant prognostic factor for poorer OS (HR 1.387, 95% CI 1.142-1.683), CSS (HR 1.587, 95% CI 1.229-2.050), and DFS (HR 1.378, 95% CI 1.122-1.693).
UNASSIGNED: Preoperative local symptoms were significantly associated with oncological outcomes, whereas symptomatic hydronephrosis and hematuria had opposite prognostic effects. Preoperative symptoms may provide additional information on risk stratification and perioperative treatment selection for patients with UTUC.