Does preoperative symptom classification impact prognosis in patients with clinically localized upper-tract urothelial carcinoma managed by radical nephroureterectomy?

被引：67

作者：

Raman, Jay D. ^{[1
,2
]}

Shariat, Shahrokh F. ^{[3
,4
]}

Karakiewicz, Pierre I. ^{[5
]}

Lotan, Yair ^{[3
]}

Sagalowsky, Arthur I. ^{[3
]}

Roscigno, Marco ^{[6
]}

Montorsi, Francesco ^{[6
]}

Bolenz, Christian ^{[7
]}

Weizer, Alon Z. ^{[8
]}

Wheat, Jeffery C. ^{[8
]}

Ng, Casey K. ^{[1
]}

Scherr, Douglas S. ^{[1
]}

Remzi, Mesut ^{[9
]}

Waldert, Matthias ^{[9
]}

Wood, Christopher G. ^{[10
]}

Margulis, Vitaly ^{[10
]}

机构：

[1] New York Presbyterian Hosp, Weill Cornell Med Ctr, New York, NY 10021 USA

[2] Penn State Milton S Hershey Med Ctr, Hershey, PA 17033 USA

[3] Univ Texas SW Med Ctr Dallas, Dallas, TX 75399 USA

[4] Mem Sloan Kettering Canc Ctr, New York, NY 10021 USA

[5] Univ Montreal, Montreal, PQ, Canada

[6] Univ Vita Salute San Raffaele, Milan, Italy

[7] Univ Hosp Mannheim, Mannheim, Germany

[8] Univ Michigan, Ann Arbor, MI 48109 USA

[9] Med Univ Vienna, Vienna, Austria

[10] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA

来源：

UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS | 2011年 / 29卷 / 06期

关键词：

Urothelial carcinoma; Hematuria; Flank pain; Constitutional symptoms; RENAL-CELL CARCINOMA; UPPER URINARY-TRACT; SURVIVAL; CANCER; EXPERIENCE; NECROSIS; OUTCOMES; MODEL;

D O I：

10.1016/j.urolonc.2009.11.007

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Objectives: To evaluate if preoperative symptom classification could refine prediction of outcomes for patients with clinically localized upper-tract urothelial carcinoma (UTUC) managed by radical nephroureterectomy (RNU). Methods: Data on 654 patients with localized UTUC who underwent RNU were reviewed. Preoperative symptoms were classified as incidental (S1), local (S2), and systemic (S3). Clinical and pathologic data were compared between the cohorts. Kaplan-Meier analyses and Cox proportional hazard modeling were used to determine recurrence-free and cancer-specific survival amongst the symptom cohorts. Results: Symptom classification was SI in 213 (33%) patients, S2 in 402 (61%), and S3 in 39 (6%). S3 symptoms were associated with advanced pathology, including higher stage, grade, and lymph node (LN) positivity. Five and 10-year recurrence-free and cancer-specific survival estimates were similar for patients with SI and S2 symptoms (P = 0.75 and 0.58, respectively), but was worse for patients with S3 symptoms (P < 0.001 for both). On multivariate analysis adjusting for final pathologic stage, grade, and LN status, S3 symptoms were not an independent predictor of recurrence (HR 1.44, P = 0.19) or death due to disease (HR 1.66, P = 0.07). Addition of symptom classification, however, increased the accuracy of a model consisting of stage, grade, and LNs for prediction of recurrence-free and cancer-specific survival by 1.4% and 1.3%, respectively (P < 0.001 for both). Conclusions: Local symptoms do not confer worse prognosis compared with patients with incidentally detected UTUC. However, systemic symptoms are associated with worse outcomes despite apparently effective RNU. Patients with systemic symptoms may harbor micrometastatic disease and could potentially benefit from a more rigorous metastatic evaluation or perioperative chemotherapy regimens. (C) 2011 Elsevier Inc. All rights reserved.

引用

页码：716 / 723

页数：8