Clinical, Prognosis, and Treatment Effect Features Analysis of Metachronous and Synchronous UTUC and BUC

IF 2.3 3区医学 Q3 ONCOLOGY Clinical genitourinary cancer Pub Date : 2024-08-12 DOI:10.1016/j.clgc.2024.102192

Wei Zuo , Jilong Zhang , Liqing Xu, Gengyan Xiong, Chunru Xu, Qi Tang, Xuesong Li, Liqun Zhou

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Abstract

Objective

To provide a comprehensive understanding of the clinical features of patients with synchronous and metachronous upper tract urothelial carcinoma (UTUC) and bladder urothelial carcinoma (BUC) and inform surgical and postoperative adjuvant treatment planning.

Patients and Method

A total of 292 consecutive patients with synchronous and metachronous UTUC-BUC were retrospectively enrolled and were categorized into three groups: (1) UTUC metachronous BUC (N = 185, UTUC-mBUC), (2) BUC-metachronous UTUC (N = 43, BUC-mUTUC), (3) synchronous UTUC-BUC (N = 64, sUTUC-BUC). We compared pathological characteristics and survival data among groups with Wilcoxon's rank sum tests, Pearson's chi-squared, and the Kaplan–Meier method.

Results

In the sUTUC-BUC group, a higher proportion of patients exhibited UTUC tumors with grade G3 (56%, P = .001) and stage T4 (6%, P < .001) than group UTUC-mBUC (G3 = 16%, T4 = 0%). The proportion of patients with variant histology subtype in group sUTUC-BUC was higher than that of metachronous UTUC-BUC, involving squamous (P = .003), adenoid (P = .012), and sarcomatoid (P < .001) differentiation. It was also observed that the maximum diameter of the UTUC tumor of group sUTUC-BUC (median = 3.5) was significantly larger than group UTUC-mBUC (median = 2.5, P = .002) and group BUC-mUTUC (median = 2.2, P < .001). Notably, sUTUC-BUC has an increased risk of cancer-specific death compared with UTUC-mBUC (P < .001) and BUC-mUTUC (P < .001). On multivariable Cox regression, synchronous UTUC-BUC was an independent predictor of both RFS (P < .001; vs. UTUC-mBUC: HR 0.555, P = .004; vs. BUC-mUTUC: HR 0.279, P < .001) and CSS (P < .001, HR 29.737). Moreover, sUTUC-BUC showed a better response to intravesical therapy and chemotherapy with higher cancer-specific survival (P < .001) and recurrence-free survival (P = .034).

Conclusions

The prognosis and pathological characteristics among different metachronous and synchronous UTUC and BUC were diverse. The synchronous UTUC-BUC group showed variant histology subtype, high-grade tumors, advanced tumors, multifocal UTUC, worse cancer-specific survival, but better response to intravesical therapy and chemotherapy.

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UTUC和BUC异时性和同步性的临床、预后和治疗效果特征分析

目的：全面了解同步和近同步上尿路上皮癌（UTUC）和膀胱尿路上皮癌（BUC）患者的临床特征，为手术和术后辅助治疗计划提供依据。我们回顾性地纳入了292例连续的同步和近同步UTUC-BUC患者，并将其分为三组：(1) UTUC近同步BUC（=185，UTUC-MBUC），(2) BUC近同步UTUC（=43，BUC-MUTUC），(3) 同步UTUC-BUC（=64，sUTUC-BUC）。我们用Wilcoxon秩和检验、Pearson秩方和Kaplan-Meier法比较了各组的病理特征和生存数据。与UTUC-mBUC组（G3 = 16%，T4 = 0%）相比，sUTUC-BUC组中UTUC肿瘤G3级（56%，= .001）和T4期（6%，< .001）的患者比例更高。在sUTUC-BUC组中，变异组织学亚型患者的比例高于UTUC-BUC的变异组织学亚型，涉及鳞状（= .003）、腺样（= .012）和肉瘤样（< .001）分化。研究还发现，sUTUC-BUC 组 UTUC 肿瘤的最大直径（中位数 = 3.5）明显大于 UTUC-mBUC 组（中位数 = 2.5， = .002）和 BUC-mUTUC 组（中位数 = 2.2， < .001）。值得注意的是，与UTUC-mBUC（< .001）和BUC-mUTUC（< .001）相比，sUTUC-BUC的癌症特异性死亡风险更高。在多变量考克斯回归中，同步UTUC-BUC是RFS（< .001；与UTUC-mBUC相比：HR 0.555，= .004；与BUC-mUTUC相比：HR 0.279，< .001）和CSS（< .001，HR 29.737）的独立预测因子。此外，sUTUC-BUC 对膀胱内治疗和化疗的反应更好，癌症特异性生存率（< .001）和无复发生存率（= .034）更高。不同的同步UTUC和BUC的预后和病理特征各不相同。同步UTUC-BUC组显示出组织学亚型变异、高级别肿瘤、晚期肿瘤、多灶性UTUC、较差的癌症特异性生存率，但对膀胱内治疗和化疗的反应较好。

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来源期刊

Clinical genitourinary cancer 医学-泌尿学与肾脏学

CiteScore

5.20

自引率

6.20%

发文量

201

审稿时长

54 days

期刊介绍： Clinical Genitourinary Cancer is a peer-reviewed journal that publishes original articles describing various aspects of clinical and translational research in genitourinary cancers. Clinical Genitourinary Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of genitourinary cancers. The main emphasis is on recent scientific developments in all areas related to genitourinary malignancies. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.