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CC BY-NC-ND 4.0 · Revista Urología Colombiana / Colombian Urology Journal 2018; 27(01): 055-062
DOI: 10.1055/s-0038-1637013
Original Article | Artículo Original
Sociedad Colombiana de Urología. Publicado por Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Factores Pronósticos de Recurrencia y Mortalidad en los Pacientes con Tumor de Urotelio Superior Tratados con Cirugía

Prognostic Factors for Recurrence and Mortality in Upper Urinary Tract Tumor
Juan Aragón Chamizo
1   Hospital General Universitario Gregorio Marañón, Madrid, Spain
2   Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
,
Felipe Herranz Amo
1   Hospital General Universitario Gregorio Marañón, Madrid, Spain
,
Carmen González Enguita
1   Hospital General Universitario Gregorio Marañón, Madrid, Spain
,
Carlos Hernández Fernández
1   Hospital General Universitario Gregorio Marañón, Madrid, Spain
› Author Affiliations
Further Information

Publication History

10 October 2016

03 October 2017

Publication Date:
08 March 2018 (online)

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Resumen

Objetivo Identificar factores pronósticos de recurrencia y mortalidad cáncer-específica en pacientes con tumor de urotelio superior tratados con cirugía.

Material y Métodos Análisis retrospectivo de pacientes con tumor de urotelio superior operados entre 1999 y 2011 (139 pacientes). Se recogieron variables demográficas, clínicas, diagnósticas y patológicas así como el tratamiento, las complicaciones y la evolución. Análisis descriptivo mediante la prueba de la Chi cuadrado para variables categóricas y el test ANOVA para variables continuas. Análisis univariante y multivariante mediante modelo de riesgos proporcionales de Cox. Significación estadística si p < 0,05. Cálculos realizados con SPSS statistics v-21.

Resultados En el análisis multivariante se identificaron como factores predictores independientes de recurrencia: crecimiento sólido tumoral (HR = 4,02; p < 0,001) y alto grado citológico (G3) (HR = 3,42; p = 0,01). La presencia de tumor vesical previo o concomitante (HR = 1,84; p = 0,07) presentó una tendencia a la significación. Se identificaron como factores predictores independientes de mortalidad cáncer-específica: presencia de tumor vesical previo o concomitante (HR = 2,23; p = 0,02), crecimiento sólido tumoral (HR = 2,73; p = 0,008), presencia de hidronefrosis (HR = 2,46; p = 0,02) y estadio patológico avanzado pT3-pT4 (HR = 2,74; p = 0,01).

Conclusión En nuestra serie, la existencia de tumor vesical previo o sincrónico, el crecimiento tumoral sólido y el alto grado citológico se comportaron como factores pronósticos de recurrencia. La hidronefrosis, el tumor vesical previo o sincrónico, el estadio pT3–4 y el crecimiento tumoral sólido, se comportaron como factores pronósticos de mortalidad cáncer-específica.

Abstract

Objective To identify predictors of recurrence and cancer-specific mortality in patients with upper urinary tract carcinoma treated with surgery.

Material and Methods Retrospective analysis of patients with upper urinary tract urothelial carcinoma getting surgery between 1999 and 2011 in our institution (139 patients). We collected demographic, clinical, pathological and diagnostic variables as well as the treatment performed, the occurred complications and the evolution. A descriptive analysis was performed using the Chi square test for categorical variables and the ANOVA test for continuous variables. We performed an univariate and multivariate analysis using a proportional Cox risks model. Statistical significance was considered when p < 0.05. All calculcations were performed with SPSS statistics v-21.

Results In the multivariate analysis, the solid tumor growth (HR = 4.02; p < 0.001) and a high cytological grade (G3) (HR = 3.42; p = 0.01) were identified as independent predictors; the presence of previous or concomitant bladder tumor (HR = 1.84; p = 0.07) showed a trend to statistical significance. In the multivariate analysis, the presence of previous or concomitant bladder tumor (HR = 2.23; p = 0.02), the solid tumor growth (HR = 2.73; p = 0.008), the presence of hydronephrosis (HR = 2.46; p = 0.02) and the advanced pathological stage pT3-pT4 (HR = 2.74; p = 0.01) were identified as independent predictors of cancer-specific mortality.

Conclusion The existence of previous or concomitant bladder cancer at the diagnosis of upper urinary tract carcinoma, solid growth pattern and high cytological grade (G3) were identified as independent predictors of recurrence in our series. The existence of hydronephrosis at diagnosis, prior or concomitant bladder tumor, pathologic stage pT3–4 and the solid growth pattern were identified as independent predictors of cancerspecific mortality.

Palabras Claves

factores pronósticos - tumor urotelial - tumor de tracto urinario superior - cirugía - recurrencia - mortalidad cáncer-específica

Keywords

prognostic factors - urothelial tumor - upper urinary tract carcinoma - surgery - recurrence - cancer-specific mortality

Responsabilidades Éticas

Protección de personas y animales. Los autores declaran que para esta investigación no se han realizado experimentos en seres humanos ni en animales.


Confidencialidad de los datos. Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicación de datos de pacientes.


Derecho a la privacidad y consentimiento informado. Los autores declaran que en este artículo no aparecen datos de pacientes.


 

  • Referencias

  • 1 Munoz JJ, Ellison LM. Upper tract urothelial neoplasms: incidence and survival during the last 2 decades. J Urol 2000; 164 (05) 1523-1525
    CrossrefPubMedSearch in Google Scholar
  • 2 Chromecki TF, Ehdaie B, Novara G. , et al. Chronological age is not an independent predictor of clinical outcomes after radical nephroureterectomy. World J Urol 2011; 29 (04) 473-480
    CrossrefPubMedSearch in Google Scholar
  • 3 Lehmann J, Suttmann H, Kovac I. , et al. Transitional cell carcinoma of the ureter: prognostic factors influencing progression and survival. Eur Urol 2007; 51 (05) 1281-1288
    CrossrefPubMedSearch in Google Scholar
  • 4 Jeldres C, Sun M, Isbarn H. , et al. A population-based assessment of perioperative mortality after nephroureterectomy for upper-tract urothelial carcinoma. Urology 2010; 75 (02) 315-320
    CrossrefPubMedSearch in Google Scholar
  • 5 Fernández MI, Shariat SF, Margulis V. , et al. Evidence-based sex-related outcomes after radical nephroureterectomy for upper tract urothelial carcinoma: results of large multicenter study. Urology 2009; 73 (01) 142-146
    CrossrefPubMedSearch in Google Scholar
  • 6 Shariat SF, Favaretto RL, Gupta A. , et al. Gender differences in radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol 2011; 29 (04) 481-486
    CrossrefPubMedSearch in Google Scholar
  • 7 Cosentino M, Palou J, Gaya JM, Breda A, Rodriguez-Faba O, Villavicencio-Mavrich H. Upper urinary tract urothelial cell carcinoma: location as a predictive factor for concomitant bladder carcinoma. World J Urol 2013; 31 (01) 141-145
    CrossrefPubMedSearch in Google Scholar
  • 8 Lughezzani G, Burger M, Margulis V. , et al. Prognostic factors in upper urinary tract urothelial carcinomas: a comprehensive review of the current literature. Eur Urol 2012; 62 (01) 100-114
    CrossrefPubMedSearch in Google Scholar
  • 9 Simsir A, Sarsik B, Cureklibatir I, Sen S, Gunaydin G, Cal C. Prognostic factors for upper urinary tract urothelial carcinomas: stage, grade, and smoking status. Int Urol Nephrol 2011; 43 (04) 1039-1045
    CrossrefPubMedSearch in Google Scholar
  • 10 Rink M, Xylinas E, Margulis V. , et al; Upper Tract Urothelial Carcinoma Collaboration. Impact of smoking on oncologic outcomes of upper tract urothelial carcinoma after radical nephroureterectomy. Eur Urol 2013; 63 (06) 1082-1090
    CrossrefPubMedSearch in Google Scholar
  • 11 Raman JD, Shariat SF, Karakiewicz PI. , et al; Upper-Tract Urothelial Carcinoma Collaborative Group. Does preoperative symptom classification impact prognosis in patients with clinically localized upper-tract urothelial carcinoma managed by radical nephroureterectomy?. Urol Oncol 2011; 29 (06) 716-723
    CrossrefPubMedSearch in Google Scholar
  • 12 Inman BA, Tran VT, Fradet Y, Lacombe L. Carcinoma of the upper urinary tract: predictors of survival and competing causes of mortality. Cancer 2009; 115 (13) 2853-2862
    CrossrefPubMedSearch in Google Scholar
  • 13 Williams AK, Kassouf W, Chin J. , et al. Multifocality rather than tumor location is a prognostic factor in upper tract urothelial carcinoma. Urol Oncol 2013; 31 (07) 1161-1165
    CrossrefPubMedSearch in Google Scholar
  • 14 Isbarn H, Jeldres C, Shariat SF. , et al. Location of the primary tumor is not an independent predictor of cancer specific mortality in patients with upper urinary tract urothelial carcinoma. J Urol 2009; 182 (05) 2177-2181
    CrossrefPubMedSearch in Google Scholar
  • 15 Favaretto RL, Shariat SF, Chade DC. , et al. The effect of tumor location on prognosis in patients treated with radical nephroureterectomy at Memorial Sloan-Kettering Cancer Center. Eur Urol 2010; 58 (04) 574-580
    CrossrefPubMedSearch in Google Scholar
  • 16 Raman JD, Ng CK, Scherr DS. , et al. Impact of tumor location on prognosis for patients with upper tract urothelial carcinoma managed by radical nephroureterectomy. Eur Urol 2010; 57 (06) 1072-1079
    CrossrefPubMedSearch in Google Scholar
  • 17 Akdogan B, Dogan HS, Eskicorapci SY, Sahin A, Erkan I, Ozen H. Prognostic significance of bladder tumor history and tumor location in upper tract transitional cell carcinoma. J Urol 2006; 176 (01) 48-52
    CrossrefPubMedSearch in Google Scholar
  • 18 Ouzzane A, Colin P, Xylinas E. , et al; French Collaborative National Database on UUT-UC. Ureteral and multifocal tumours have worse prognosis than renal pelvic tumours in urothelial carcinoma of the upper urinary tract treated by nephroureterectomy. Eur Urol 2011; 60 (06) 1258-1265
    CrossrefPubMedSearch in Google Scholar
  • 19 Park J, Ha SH, Min GE. , et al. The protective role of renal parenchyma as a barrier to local tumor spread of upper tract transitional cell carcinoma and its impact on patient survival. J Urol 2009; 182 (03) 894-899
    CrossrefPubMedSearch in Google Scholar
  • 20 Cho KS, Hong SJ, Cho NH, Choi YD. Grade of hydronephrosis and tumor diameter as preoperative prognostic factors in ureteral transitional cell carcinoma. Urology 2007; 70 (04) 662-666
    CrossrefPubMedSearch in Google Scholar
  • 21 Ito Y, Kikuchi E, Tanaka N. , et al. Preoperative hydronephrosis grade independently predicts worse pathological outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma. J Urol 2011; 185 (05) 1621-1626
    CrossrefPubMedSearch in Google Scholar
  • 22 Ng CK, Shariat SF, Lucas SM. , et al. Does the presence of hydronephrosis on preoperative axial CT imaging predict worse outcomes for patients undergoing nephroureterectomy for upper-tract urothelial carcinoma?. Urol Oncol 2011; 29 (01) 27-32
    CrossrefPubMedSearch in Google Scholar
  • 23 Novara G, De Marco V, Gottardo F. , et al. Independent predictors of cancer-specific survival in transitional cell carcinoma of the upper urinary tract: multi-institutional dataset from 3 European centers. Cancer 2007; 110 (08) 1715-1722
    CrossrefPubMedSearch in Google Scholar
  • 24 Mullerad M, Russo P, Golijanin D. , et al. Bladder cancer as a prognostic factor for upper tract transitional cell carcinoma. J Urol 2004; 172 (6 Pt 1): 2177-2181
    CrossrefPubMedSearch in Google Scholar
  • 25 Margulis V, Shariat SF, Matin SF. , et al; Upper Tract Urothelial Carcinoma CollaborationThe Upper Tract Urothelial Carcinoma Collaboration. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer 2009; 115 (06) 1224-1233
    CrossrefPubMedSearch in Google Scholar
  • 26 Lughezzani G, Jeldres C, Isbarn H. , et al. A critical appraisal of the value of lymph node dissection at nephroureterectomy for upper tract urothelial carcinoma. Urology 2010; 75 (01) 118-124
    CrossrefPubMedSearch in Google Scholar
  • 27 Fajkovic H, Cha EK, Jeldres C. , et al. Prognostic value of extranodal extension and other lymph node parameters in patients with upper tract urothelial carcinoma. J Urol 2012; 187 (03) 845-851
    CrossrefPubMedSearch in Google Scholar
  • 28 Raman JD, Messer J, Sielatycki JA, Hollenbeak CS. Incidence and survival of patients with carcinoma of the ureter and renal pelvis in the USA, 1973-2005. BJU Int 2011; 107 (07) 1059-1064
    CrossrefPubMedSearch in Google Scholar
  • 29 Ehdaie B, Chromecki TF, Lee RK. , et al. Obesity adversely impacts disease specific outcomes in patients with upper tract urothelial carcinoma. J Urol 2011; 186 (01) 66-72
    CrossrefPubMedSearch in Google Scholar