Prognostic value of platelet-to-lymphocyte ratio in upper tract urothelial carcinoma patients treated with radical nephroureterectomy:A metaanalysis

Objective:To evaluate the prognostic value of platelet-to-lymphocyte ratio(PLR)in upper tract urothelial carcinoma(UTUC)patients treated with radical nephroureterectomy.Methods:This study was pre-registered in PROSPERO(No.CRD42020186645).Two reviewers independently performed a comprehensive literature search on PubMed,Web of Science,EMBASE,Cochrane Library databases,China Biology Medicine disc(CBM),Wanfang database,and China National Knowledge Infrastructure(CNKI)from inception to May 2021 for prospective or retrospective cohort studies evaluating the prognostic value of PLR.Literature was analyzed with inclusion and exclusion criteria.Data and other useful clinicopathological features were extracted and analyzed with fixed or random-effect models when applicable.Heterogeneity was assessed on the basis of Cochran’s Q test and I2 statistic.Publication bias was assessed with funnel plots and precisely assessed by Egger's tests.Results:A total of ten studies involving 3287 UTUC patients were included.Meta-analysis showed that elevated preoperative PLR was associated with worse overall survival(HR=1.51,95%CI 1.17-1.94,P=0.001),cancer specific survival(HR=1.52,95%CI 1.21-1.90,P<0.001),disease free survival(HR=1.32,95%CI 1.12-1.56,P=0.001),and progression free survival(HR=1.88,95%CI 1.41-2.52,P<0.001).Furthermore,the sensitivity analyses validated the stability and reliability of the results.Conclusion:The present meta-analysis demonstrates a significant association between elevated preoperative PLR and poor prognosis of UTUC patients treated with radical nephroureterectomy.Hence,PLR could be helpful as a potential prognostic biomarker to guide clinical decision-making and select individualized treatment strategies for UTUC patients.However,more prospective and large-scale trials are needed to provide more evidence.

Research progress in genomics associated with prognosis of upper tract urothelial carcinoma

Upper tract urothelial carcinoma and bladder urothelial carcinoma both belong to urothelial carcinoma,which is a malignant tumor occurring in the renal pelvis and ureteral urothelium.The incidence rate of UTUC is higher among Asians and it shows various pathogenic factors.Patients of UTUC have a short lifespan,and most of them have shown invasive malignant tumors at the time of initial diagnosis.The treatment of most UTUC patients is limited to surgical resection,radiotherapy and chemotherapy in clinical.Due to its rarity,the studies on targeted therapy are rare.With the development of the targeted therapy and immunotherapy,genomics exploration that affects the prognosis of UTUC becomes particularly important.In this paper,we intend to review the differential expression,clinical significance and some special types of UTUC genomes through the UTUC genome.

Percutaneous resection of upper tract urothelial cell carcinoma:When,how,and is it safe?

Introduction:In the management of upper tract urothelial cell carcinoma(UTUC)endoscopic,nephron sparing procedures like ureterorenoscopy(URS)or percutaneous tumour resection(PCTR)still play a very limited role.This could lead to possible unnecessary radical nephroureterectomies(RNU),still being the gold standard treatment.The risk of chronic kidney disease(CKD)later in life is important.In this study we present the results of 24-year experience with PCTR in a single institution.Methods:We identified 44 patients who underwent PCTR between 1992 and 2015.Radical resection was achieved in 40 patients who were included in this study.Demographic and clinical data,including tumour recurrence,progression to RNU,tumour grade and overall survival(OS)were retrospectively acquired.An outcome analysis was conducted.Results:Median age at diagnosis was 68 years(range 42-94 years).Low grade tumours were found in 37 patients(92.5%)and high grade tumours in three patients(7.5%).Median followup was 53 months during which 20 patients developed upper tract recurrences(50.0%).The longest time to recurrence was 97 months.At follow-up 11 patients(27.5%)underwent an RNU and two patients died from UTUC.RNU could be avoided in 29 patients(72.5%).In this study we found that multifocality is a significant risk factor for recurrence,but not for stage progression to RNU.Conclusion:PCTR is a surgically and oncologically safe procedure.Renal preservation in patients with UTUC who are eligible for percutaneous resection can be achieved in the majority of patients.Selection criteria for PCTR should be further refined,leading to a wider application of PCTR in the future.Follow-up needs invasive procedures and should be long term.

Oncological impact of different distal ureter managements during radical nephroureterectomy for primary upper urinary tract urothelial carcinoma

BACKGROUND The current standard surgical treatment for non-metastatic upper urinary tract urothelial carcinoma(UTUC)is radical nephroureterectomy(RNU)with bladder cuff excision(BCE).Typically,BCE techniques are classified in one of the following three categories:An open technique described as intrasvesical incision of the bladder cuff,a transurethral incision of the bladder cuff(TUBC),and an extravesical incision of the bladder cuff(EVBC)method.Even though each of these management techniques are widely used,there is no consensus about which surgical intervention is superior,with the best oncologic outcomes.AIM To investigate the oncological outcomes of three BCE methods during RNU for primary UTUC patients.METHODS We retrospectively analyzed the data of 248 primary UTUC patients,who underwent RNU with BCE between January 2004 to December 2018.Patients were analyzed according to each BCE method.Data extracted included patient demographics,perioperative parameters,and oncological outcomes.Statistical analyses were performed using chi-square and log-rank tests.The Cox proportional hazards regression model was utilized to identify independent predictors.P<0.05 was considered statistically significant.RESULTS Of the 248 participants,39.9%(n=99)underwent intrasvesical incision of the bladder cuff,38.7%(n=96)EVBC,and 21.4%(n=53)TUBC.At a median followup of 44.2 mo,bladder recurrence developed in 17.2%,12.5%,and 13.2%of the cases,respectively.Cancer-specific deaths occurred in 11.1%,5.2%,and 7.5%of patients,respectively.Kaplan-Meier survival curves with a log-rank test highlighted no significant differences in intravesical recurrence-free survival,cancer-specific survival,and overall survival among these approaches with P values of 0.987,0.825,and 0.497,respectively.Multivariate analysis showed that the lower ureter location appears to have inferior intravesical recurrence-free survival(P=0.042).However,cancer-specific survival and overall survival were independently influenced by tumor stage(hazard ratio[HR]=8.439;95%con
dence interval:2.424-29.377;P=0.001)and lymph node status(HR=14.343;95%CI:5.176-39.745;P<0.001).CONCLUSION All three techniques had comparable outcomes;although,EVBC and TUBC are minimally invasive.While based upon rather limited data,these findings will support urologists in blending experience with evidence to inform patient choices.However,larger,rigorously designed,multicenter studies with long term outcomes are still required.

Who needs further evaluations to diagnose upper urinary tract urothelial cancers among patients with abnormal findings by enhanced CT?

Objective:We evaluated who would need further evaluations such as retrograde pyelography(RP)and/or ureteroscopy to diagnose upper urinary tract urothelial cancers(UUTUCs)when abnormal findings for the upper urinary tract(UUT)were detected by enhanced computed tomography(CT).Methods:We retrospectively analyzed 125 patients who underwent enhanced CT for various reasons and had abnormal findings for the UUT.Patients whose tumors were suspected to be of extraureteral origin were excluded.All patients received RP and/or ureteroscopy to evaluate the UUTUCs.Results:The median age of the 125 patients was 70 years and gross hematuria(26.4%)was the most frequently observed symptoms.RP,ureteroscopy and both were performed for 121,59 and 55 patients,respectively.CT revealed tumor-like lesions in 58 patients and the other patients had non-tumor-like lesions.UUTUCs were found in 43(34.4%)of the 125 patients.All of them had tumor-like lesions on CT.In 58 patients who had tumor-like lesions on CT,univariate and multivariate analyses revealed that tumor diameter and tumor enhancement were significant predictive factors for UUTUCs.ROC curve analysis of enhanced CT to diagnose UUTUCs revealed that a tumor diameter of 18 mm was the best cutoff point.The sensitivity,specificity and accuracy were 90.0%,98.8% and 92.7% for RP and 95.5%,100% and 97.1%for ureteroscopy,respectively.Both of them had high sensitivity,specificity and accuracy.Conclusion:We should decide to evaluate the UUT according to the tumor diameter on enhanced CT.When we evaluate the UUT in patients with tumor diameters of less than 20 mm,ureteroscopy is recommended.

Contemporary management of upper tract urothelial cell carcinoma

Upper tract urothelial cell carcinoma(UTUCC),formerly known as transitional cell carcinoma of the upper urinary tract,is a rare oncologic disease in Western countries.Thus its disease process and its management are not as well defined as other urologic cancers. We are reviewing the current evidence based literature available to develop a plan for the treatment of UTUCC. A Pub Med search was completed using the key words "upper tract urothelial cell carcinoma","epidemiology","risk factor","treatment" and "prognosis". Six hundred fifty two articles were found. We narrowed our search to articles published between January 2004 and June 2016 for a more contemporary review of the topic. Four hundred seventy articles were then available for review. Further detailed search was performed for relevance on the topic and hundred one articles were selected for the review. Many risk factors have been found to be associated with the development of UTUCC,including tobacco use. Patients are often asymptomatic and may only present with microscopic or gross hematuria. Tumor grade and stage are pivotal in determining the treatment options for UTUCC. Advancements in endoscopic techniques have aided in the diagnosis,grading and treatment of this disease. Treatment options include topical therapy,with combinations of methotrexate,vinblastine,doxorubicin and cisplatin or gemcitibine or cisplatin,endoscopic resection,segmental ureterectomy and ureteral implantation,and nephroureterectomy,including bladder cuff. Treatment recommendations depend on tumor grade and stage,renal function,tumor location and the patient's prognosis. There are currently no tissue or blood-based biomarkers available to accurately monitor the disease. Further studies of gene expression and biomarkers may hopefully improve the management of this disease. Although rare in many countries,UTUCC is becoming more prevalent due to exposure to carcinogenic herbal remedies and other identifiable risk factors. Numerous treatment modalities,both surgical and chemotherapeutic,have been utilized to treat both low and high grade UTUCC tumors. Additional clinical trials are necessary to further develop methods for screening,treatment,and surveillance to improve management.

Segmental ureteroileal conduit resection for the treatment of distal upper urinary tract recurrence of bladder cancer fol lowing cystectomy

Segmental ureterectomy is less invasive than radical nephroureterectomy and results in nephron preservation and satisfactory tumor control.This study was to determine the feasibility of segmental ureteroileal conduit resection(SUICR) for patients with distal upper urinary tract recurrence of bladder cancer following radical cystectomy.Four patients with high-grade distal upper urinary tract recurrence underwent SUICR 15-108 months after radical cystectomy.The surgical technique details of SUICR,operative results,and follow-up outcomes are reported.The median operation time was 280 min,and estimated blood loss was less than 100 ml One patient suffered from ileus 5 days after surgery and was managed conservatively.Histopathologic evaluation showed high-grade stages pTa-pT1 diseases for these patients,and ureteral margins were all negative.No patient suffered from tumor recurrence,with a median follow-up of 39 months.SUICR preserved the ipsilateral renal unit and conformed to oncological principles during surgery.The oncological outcome was satisfactory for these properly selected patients.This technique provides a valid alternative to nephroureterectomy for patients with imperative indications and high-grade upper urinary tract recurrence of bladder cancer following radical cystectomy.

Laparoscopic nephroureterectomy for upper tract urothelial carcinoma-Update

Upper urinary tract urothelial carcinomas(UTUCs)are uncommon and account for only 5%e10%of urothelial carcinomas.Pyelocaliceal tumors are about twice as common as ureteral tumors.Sixty percent of UTUCs are invasive at diagnosis.Radical nephroureterectomy,including the excision of the distal ureter and bladder cuff is standard of care for treatment of localized UTUCs,because of the high potential for recurrence,multifocality,and progression.Since first laparoscopic nephroureterectomy(LNU)was introduced by Clayman et al.in 1991 and improvement of laparoscopic technique and equipment,LNU has been reported to be equivalent to conventional open method.We reviewed the current literature of patients with UTUCs treated by LNU focusing on technical aspects,peri-operative and oncological outcomes.Laparoscopic radical nephroureterectomy offers the advantages of minimally invasive surgery without deteriorating the oncological outcome for treatment of UTUCs.Indications tend to increase as operator skills increase.Indications for laparoscopic or open nephroureterectomy are in principle the same.The basic requirement for laparoscopic surgery in UTUCs is to achieve benefits of minimal invasive surgery and maintain oncologic principles.

Prognostic Factors and Oncological Outcomes after Radical Nephroureterctomy for Upper Tract Urothelial Carcinoma: Review of Contemporary Multi-Center Series

Upper tract urothelial cancers (UTUC) are uncommon and the information guiding their management used to be driven from small single center studies. Multi-center international collaborations should provide clinicians with best management practices as well as prognostic factors guiding treatment decisions and outcomes. We reviewed literature from the largest multicenter collaborations for radical nephroureterctomy (RNU) performed for management of UTUC. Our review included over 50 recent manuscripts from 2009-2012 that were published from multi-center UTUC collaboration groups. Our review aims to determine of the prognostic factors predicting oncological outcomes after RNU and to provide insights about possible maximization of cure with utilization of multimodal treatment approaches. Application of approaches comprising RNU including lymphadenectomy and systemic chemotherapy;particularly in neoadjuvant settings;might have implications on improvement of oncological outcomes in high risk patients.

Upper tract urothelial carcinoma: Paradigm shift towards nephron sparing management

Upper tract urothelial carcinoma （UTUC） is relatively rare compared to urothelial carcinoma of the lower tract, comprising only 5%-10% of all urothelial cancers. Although both entities share histologic properties, UTUC tends to be more invasive at diagnosis and portend a worse prognosis, with a 5 year overall mortality of 23%. To date, the gold standard management of UTUC has been radical nephroureterectomy （RNU）, with nephron sparing techniques reserved for solitary kidneys or cases where the patient could not tolerate radical surgery. Limited data from these series, as well as select series where nephron-sparing endoscopic management has been offered to a broader patient base, suggest that minimally invasive, nephron sparing techniques can offer comparable oncologic and survival outcomes to RNU in appropriately selected patients. We review the current literature on the topic and discuss long term outcomes and sequelae of the gold standard treatment, RNU. We also discuss the oncologic outcomes of minimally invasive, endoscopic management of UTUC. Our goal is to provide the reader a comprehensive overview of the current state of the feld in order to inform and guide their treatment decisions.

Conservative management of an early abdominal complication during a Tullio percutaneous endoscopic excision of renal pelvis urothelial carcinoma:A case report

BACKGROUND Upper tract urothelial carcinoma(UTUC)representing only a small fraction of all urothelial tumors.It predominantly affects the renal pelvis in men,often coexisting with bladder carcinoma.UTUC displays a more aggressive genetic profile compared to bladder neoplasms,with the majority of patients presenting with advanced disease.Histologically,about a quarter of UTUC cases exhibit high-grade subtypes,associated with a worse prognosis.Tobacco use and past exposure to aromatic amines are significant risk factors for UTUC.Imaging modalities such as Uro-computed tomography and magnetic resonance imaging play crucial roles in diagnosis.Ureterorenoscopy is vital for direct visualization and biopsy sampling,but its limited sampling capacity presents challenges in determining tumor depth and staging.Traditionally,nephroureterectomy with bladder cuff excision has been the gold-standard treatment for UTUC.Endoscopic conservative treatment has recently emerged as a viable option for selected patients,offering comparable oncological outcomes to radical surgery.Percutaneous access is also feasible for larger intrarenal tumors.CASE SUMMARY We present a case of an 84-year-old woman who underwent percutaneous endoscopic excision of a renal pelvis neoplasm using the Tullio laser.Despite successful tumor removal,the patient experienced a postoperative complication with abdominal fluid leakage.Conservative management effectively resolved the complication.Given the patient's age and refusal for radical surgery,the conservative approach proved to be a valid therapeutic choice.CONCLUSION Overall,UTUC remains a diagnostic and therapeutic challenge due to its rarity.However,advances in endoscopic and percutaneous techniques provide valuable alternatives for selected patients,warranting further exploration in this evolving field.

Lymphoepithelioma-like carcinoma of the upper urinary tract: A systematic review of case reports

BACKGROUND Lymphoepithelioma-like carcinomas(LELCs)are rare,malignant epithelial tumors,generally considered a subtype of squamous cell carcinoma.LELCs are undifferentiated and can occur in multiple tissues,although LELCs in the urinary tract are extremely rare.As such,evidence does not provide clinicians with guidelines for the best practices.Even though this is a rare disease,it is associated with high morbidity and mortality.Therefore,we must learn to differentiate LELC types and identify risk factors for early identification.AIM To develop an evidence base to guide clinicians treating primary LELCs of the upper urinary tract(UUT-LELC).METHODS We performed a systematic review of all reports on UUT-LELC from the first published case in 1998 until October 2019,according to the PRISMA.A database was then developed by extracting data from previously published reports in order to analyze interactions between clinical characteristics,pathological features,interventions and outcomes.Survival was analyzed using Kaplan–Meier estimates,which were compared using log rank tests.RESULTS A total of 28 previously published cases were identified for inclusion.The median age was 72 years with a male to female ratio of 4:3.Pure type LELCs were most common with 48.3%(n=14),followed by 37.9%(n=11)predominant LELCs and 3.4%(n=1)focal LELCs.Epstein-Barr virus testing was negative in all cases.Fourteen patients received radical nephroureterectomy(RNU)-based intervention.Twenty-three patients survived with no evidence of further metastasis,although six died before the median 18 mo follow-up point.Survival analysis suggests pure histological subtypes,and patients who receive complete tumor resection have more favorable prognoses.As always in cancer care,early identification generally increases the probability of interventional success.CONCLUSION The most effective treatment for UUT-LELC is RNU-based therapy.Since cases are few in number,case reporting must be enhanced and publishing encouraged to both save and prolong lives.

Impact of surgical management of upper tract urothelial cancer in octogenarians:A population-based study

Background Upper tract urothelial carcinoma(UTUC)is an aggressive disease with a high progression rate.The standardmanagement for this disease is nephroureterectomy.Nephron sparing nonradical surgery is an alternative therapeutic approach.In men with limited life expectancy,the potential harm of UTUC progression must be weighed against surgical morbidity and mortality,and thus,more conservative approaches may be selected.This study aims to investigate the comparative benefits of radical and conservative surgical management in patients older than 80 years with localized UTUC.Materials and methods A search was conducted in the Surveillance,Epidemiology,and End Results database for patients older than 80 years who were diagnosed with localized(T1–2N0M0)cancer in the renal pelvis or ureter as the only malignancy from 2004 to 2015.Patients were divided into 3 therapeutic groups:no surgery,local intervention(ie,local tumor excision or segmented ureterectomy),and radical surgery(nephroureterectomy).Demographic and cancer-related parameter data were collected.Logistic regression analysis was conducted to investigate predictors for surgical treatment.Kaplan-Meier curves and Cox regression were used to analyze survival outcomes.Results Data from 774 patients were analyzed,including 205 in the no-surgery group,181 in the local intervention group,and 388 in the radical surgery group.Older,African American patients with T1 stage disease were less likely to receive surgical treatment.Among surgically treated patients,renal pelvic tumors,and high-grade and T2 stage disease were associated with radical resection.Surgically treated patients had a longer median overall survival(OS)than in those treated nonsurgically(13,35,and 47 months in no-surgery,local intervention,and radical surgery groups,respectively;p<0.001).Although surgically treated patients demonstrated higher 5-year OS(8.8%[no surgery],23.2%[local intervention],and 23.5%[radical surgery],p<0.001)and 5-year disease-specific survival(DSS)(41.0%[no surgery],69.1%[local intervention],and 72.9%[radical surgery];p<0.001)than in those treated nonsurgically,no significant differences were found between the local intervention and radical surgery groups(p>0.05).Based on multivariate Cox regression analysis,surgical treatments,including both nonradical and radical resection,were independently associated with improved OS and DSS after controlling for age,marital status,tumor grade,and radiation status.Conclusions Patients older than 80 years with localized UTUC who undergo surgery demonstrate longer survival.Radical and nonradical resections seemto have similar OS and DSS outcomes.Thus,when clinically indicated in this population,a more conservative surgical approach may be reasonable.

Follow-Up Upper Tract Imaging Post-Nephroureterectomy for TCC: Need for a Protocol Driven Approach?

Objectives: We present a retrospective analysis of follow-up strategy adapted by different clinician in managing UTUC cases. Methods: Case notes of 83 patients undergoing nephroureterectomy for UTUC at our institute were selected. Their follow-up pattern and any imaging protocols for upper tract surveillance were studied retrospectively. Results: Our study highlighted diversity in clinicians’ overall approach at a time when no approved guidelines or standardised protocols were available. Conclusions: This study clearly highlighted the need for a protocol driven approach;which has lately been addressed with the introduction of EAU guidelines on this subject matter and majority of practising Urologists will adhere to it.

Metachronous urothelial carcinoma in the renal pelvis,bladder,and urethra:A case report

BACKGROUND Urothelial carcinoma(UC)is a common malignancy of the urinary system that can occur anywhere from the renal pelvis to the proximal urethra.Most UCs are in the bladder and have multifocal growth.Upper urinary tract UC(UTUC),which occurs in the renal pelvis or ureter,accounts for only 5%to 10%of UCs.CASE SUMMARY In March 2015,a 70-year-old male who initially presented to a local hospital with a complaint of painless hematuria was diagnosed with UTUC of the right renal pelvis.The doctors administered radical nephroureterectomy and bladder cuff excision.Although the doctors recommended intravesical chemotherapy and regular follow-up,he rejected this advice.In December 2016,the patient presented at our hospital with dysuria.We identified UC in the residual bladder and administered radical cystectomy and left cutaneous ureterostomy.In November 2021,he presented again with urethral bleeding.We detected urethral UC as the cause of urethral orifice bleeding and administered radical urethrectomy.Since then,he has visited regularly for 6-mo follow-ups,and was in stable condition as of December 2022.CONCLUSION UTUC is prone to seeding and recurrence.Adjuvant instillation therapy and intense surveillance are crucial for these patients.

机器人辅助腹腔镜治疗上尿路尿路上皮癌专家共识

目前,肾输尿管全长切除联合膀胱袖状切除术是治疗上尿路尿路上皮癌的金标准。机器人辅助腹腔镜技术因其突出的优势正在被越来越多的泌尿外科医师用于上尿路尿路上皮癌的手术治疗。机器人辅助腹腔镜肾输尿管根治性切除术(RARNU)在患者体位及机器人锚定方面经历了多个阶段的探索和演变后,单一体位单次锚定的手术术式正变得越来越成熟。此外,RARNU在肿瘤控制、手术安全性和有效性方面同样有较为出色的表现。本共识主要聚焦RARNU的适应证、常用手术方式及围手术期注意事项等。

不同腹腔镜术式治疗上尿路尿路上皮癌的临床疗效比较

目的 比较经腹腹腔镜单一体位肾输尿管全长切除术(PSPNTLR)与后腹腔镜下腹部切口技术(PLSIT)治疗上尿路上皮癌(UTUC)的临床疗效。方法 选取2018年1月—2021年2月河北医科大学第二医院收治的82例UTUC患者作为研究对象,采用随机数字表法将患者分为观察组(给予PSPNTLR治疗)和对照组(给予PLSIT治疗)各41例。比较两组患者围术期指标、疼痛程度、炎症因子水平和膀胱内复发和远处转移情况。结果 两组的手术时间[(122.15±15.14)min vs.(160.88±17.26)min]、住院时间[(10.07±2.14)d vs.(12.22±3.13)d]和术后排气时间[(1.46±0.57)d vs.(3.10±0.88)d]相比,观察组均明显短于对照组,两组的术中出血量[(42.85±4.88)mL vs.(78.22±8.17)mL]、引流量[(53.61±9.74)mL vs.(81.56±11.06)mL]相比,观察组均明显少于对照组(P<0.05)。观察组术后6、12及24 h的视觉模拟评分(VAS)均显著低于对照组(P<0.05)。术后1 d两组患者的白细胞介素-6(IL-6)、C反应蛋白(CRP)水平均上升,但对照组指标上升更显著(P<0.05)。术后2年的随访期内,两组患者的膀胱内复发(12.20%vs.14.63%)和远处转移情况(9.76%vs.4.88%)比较差异无统计学意义(P>0.05)。结论 PSPNTLR与PLSIT治疗UTUC均有良好的安全性,但PSPNTLR在改善患者围术期指标、减轻患者术后疼痛、抑制机体炎症反应方面效果更优。

人表皮因子受体-2在膀胱尿路上皮癌和上尿路上皮癌中表达的差异性分析

目的探索人表皮因子受体-2(HER-2)在膀胱尿路上皮癌(UBC)和上尿路上皮癌(UTUC)中表达的差异性,及其与这两种疾病复发及进展的相关性。方法回顾性分析2015年11月—2022年6月兰州大学第二医院泌尿外科收治的184例尿路上皮癌患者,按照肿瘤部位分为UBC组及UTUC组,比较两组中HER-2的阳性表达率,绘制生存曲线。比较两组患者的无复发生存期(RFS)及无进展生存期(PFS)。应用Cox比例风险模型分析HER-2阳性表达对UBC及UTUC患者复发及进展的影响。结果UBC患者HER-2阳性表达显著高于UTUC患者(49.6%vs.32.2%,P=0.027)。UTUC患者中,肾盂癌患者HER-2阳性表达相较于输尿管癌差异无统计学意义(30.6%vs.34.8%,P>0.05)。Cox多因素回归分析显示HER-2阳性表达影响UBC复发(P<0.001);HER-2阳性表达(P<0.001)、肿瘤直径≥3 cm(P<0.001)、分期≥T2(P=0.003)以及多发肿瘤灶(P=0.033)均可影响UBC进展;HER-2阳性表达对UTUC复发及进展的影响差异无统计学意义。结论UBC组患者HER-2的阳性表达显著高于UTUC,HER-2阳性表达可能提示UBC复发及进展的风险增加,而对UTUC的复发及进展则无明显影响。因此不建议以HER-2表达来独立预测UTUC的复发及进展风险。

探究减瘤手术对合并远处转移的上尿路尿路上皮癌患者预后的影响

目的探究减瘤手术对合并远处转移的上尿路尿路上皮癌患者预后的影响。方法筛选2010年1月至2015年12月SEER数据库中已经发生远处转移的上尿路尿路上皮癌患者的临床数据,根据是否行减瘤手术分为减瘤手术组和未做减瘤手术组,比较组间基线差异。通过单因素和多因素Cox比例风险回归模型分析与已经发生远处转移的上尿路尿路上皮癌患者生存有关的预后影响因素。通过Kaplan-Meier法绘制生存曲线分析各组的生存情况。结果本研究共纳入患者238例,减瘤手术者157例,未做减瘤手术者81例,总体基线较为平稳。单因素和多因素Cox回归分析结果显示:减瘤手术、化学药物治疗(以下简称化疗)、肝转移是总生存期(overall survival,OS)的独立风险因素;减瘤手术和化疗是癌症特异性生存期(cancer special survival,CSS)的独立风险因素。Kaplan-Meier曲线显示:年龄、减瘤手术、化疗、肝转移与OS密切相关;减瘤手术、化疗、肝转移与CSS密切相关。结论对于已经发生远处转移的上尿路尿路上皮癌患者,减瘤手术可明显改善患者预后,减瘤手术、化疗、肝转移是总生存结局的独立影响因素,减瘤手术和化疗是疾病相关生存结局的独立影响因素。

术前预后营养指数在上尿路上皮癌根治性手术患者中的临床应用价值

目的探讨术前预后营养指数(PNI)在上尿路上皮癌(UTUC)根治性手术患者中的临床应用价值。方法回顾性分析2012年1月至2021年6月就诊于我院并接受根治性手术的所有UTUC患者的临床资料。根据受试者工作特征曲线(ROC)下最大约登指数确定PNI的最佳截点,比较不同PNI UTUC患者的临床病理特征;分析UTUC患者术后总生存期(OS)的影响因素及生存情况。结果术前PNI预测UTUC患者5年OS的曲线下面积(AUC)为0.672(95%CI:0.586~0.750),最佳截点值为47.63。在纳入研究的136例患者中,59例(43.38%)患者的PNI<47.63(低PNI组),77例(56.62%)患者的PNI≥47.63(高PNI组);两组的年龄、病理T分期及病理N分期比较,差异具有统计学意义(P<0.05)。Cox回归分析显示,术前病理分期为T3~T4期、N1期及PNI<47.63是UTUC患者术后OS的独立危险因素(P<0.05);Kaplan-Meier生存曲线结果提示,高PNI组患者的术后5年生存率为81.82%,显著高于低PNI组的44.07%(P<0.05)。结论术前PNI可有效地评估UTUC根治性手术患者的预后,其值越低表明患者的预后越差。