A Novel Risk-based Approach Simulating Oncological Surveillance After Radical Nephroureterectomy in Patients with Upper Tract Urothelial Carcinoma

被引：10

作者：

Shigeta, Keisuke ^{[1
]}

Kikuchi, Eiji ^{[1
]}

Abe, Takayuki ^{[2
]}

Hagiwara, Masayuki ^{[3
]}

Ogihara, Koichiro ^{[1
]}

Anno, Tadatsugu ^{[4
]}

Umeda, Kota ^{[5
]}

Baba, Yuto ^{[6
]}

Sanjo, Tansei ^{[7
]}

Shojo, Kazunori ^{[8
]}

Mikami, Shuji ^{[9
]}

Mizuno, Ryuichi ^{[1
]}

Oya, Mototsugu ^{[1
]}

机构：

[1] Keio Univ, Dept Urol, Sch Med, Tokyo, Japan

[2] Keio Univ, Dept Prevent Med & Publ Hlth, Sch Med, Biostat Unit,Clin Translat Res Ctr, Tokyo, Japan

[3] Ichikawa Gen Hosp, Dept Urol, Tokyo Dent Coll, Chiba, Japan

[4] Saitama City Hosp, Dept Urol, Saitama, Japan

[5] Kawasaki Municipal Hosp, Dept Urol, Kawasaki, Kanagawa, Japan

[6] Int Univ Hlth & Welf Mita Hosp, Dept Urol, Tokyo, Japan

[7] Isehara Kyodo Hosp, Dept Urol, Isehara, Kanagawa, Japan

[8] Natl Hosp Org Saitama Natl Hosp, Dept Urol, Saitama, Japan

[9] Keio Univ, Div Diagnost Pathol, Sch Med, Tokyo, Japan

来源：

EUROPEAN UROLOGY ONCOLOGY | 2020年 / 3卷 / 06期

关键词：

Weibull model; Intravesical recurrence; Radical nephroureterectomy; Surveillance; Survival; Upper tract urothelial carcinoma; CLINICAL-OUTCOMES; SMOKING STATUS; SURVIVAL; BLADDER; RECURRENCE; IMPACT; PROPOSAL;

D O I：

10.1016/j.euo.2019.06.021

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: The current guideline lacks evidence for creating individualized surveillance strategies for upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU). Objective: To create a novel risk model and to simulate individualized surveillance duration that dynamically illustrates the changing risk relationship of UTUC-related death and non-UTUC death, considering the impact of cigarette smoking. Design, setting, and participants: This multicenter cohort study comprised 714 pTa-T4N0M0 UTUC patients, with a median follow-up duration of 65 mo. There were 279 (39.1%) nonsmokers, 260 (36.4%) current smokers, and 175 (24.5%) ex-smokers. Intervention: All patients underwent RNU. Outcome measurements and statistical analysis: The risks of UTUC death and non-UTUC death over time were estimated using parametric models for time to failure with Weibull distributions. Age-specific, stage-specific, and smoking status-specific surveillance durations were simulated based upon Weibull estimates. Results and limitations: The hazard rate (HR) of non-UTUC death gradually increased over time in all age groups regardless of the smoking status, whereas that of UTUC-related death decreased markedly according to the pathological T (pT) stage and was affected by the smoking status. Among current smokers, the baseline HR of UTUC-related death in pT3/4 was higher than that of pT <2 and remained high even 10 yr after RNU. Among heavy smokers, the HR of UTUC-related death in all pT stages was highest at baseline and remained high after RNU, compared with nonsmokers, current smokers, or ex-smokers. We simulated specific time points when the risk of non-UTUC death was greater than that of UTUC-related death. Among patients >= 80 yr of with pT3N0M0, the risk of non-UTUC death was greater than that of UTUC-related death 1 yr after RNU in nonsmokers, but 7 yr for heavy smokers. Conclusions: Our result revealed that smokers bear a long-term risk burden of UTUC-related death more than the risk of non-UTUC death. For UTUC smokers, longer-term surveillance duration is recommended even in elderly stage. Patient summary: In the present study, we evaluated the risk transition of upper tract urothelial carcinoma (UTUC)-related death and non-cancer-related death over time. We found that smoking weighed a huge impact upon UTUC-related death compared with death from other cause, and therefore, we created a more individualized surveillance duration model. (C) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.

引用

页码：756 / 763

页数：8

共 27 条

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