Surveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma.

Autor: Locke JA; University of British Columbia, Vancouver, BC, Canada., Hamidizadeh R; University of British Columbia, Vancouver, BC, Canada., Kassouf W; McGill University, Montreal, QC, Canada., Rendon RA; Dalhousie University, Halifax, NS, Canada., Bell D; Dalhousie University, Halifax, NS, Canada., Izawa J; University of Western Ontario, London, ON, Canada., Chin J; University of Western Ontario, London, ON, Canada., Kapoor A; McMaster University, Hamilton, ON, Canada., Shayegen B; McMaster University, Hamilton, ON, Canada., Lattouf JB; University of Montreal, Montreal, QC, Canada., Saad F; University of Montreal, Montreal, QC, Canada., Lacombe L; Laval University, Quebec City, QC, Canada., Fradet Y; Laval University, Quebec City, QC, Canada., Fairey AS; University of Alberta, Edmonton, AB, Canada., Jacobson NE; University of Alberta, Edmonton, AB, Canada., Drachenberg DE; University of Manitoba, Winnipeg, MB, Canada., Cagiannos I; University of Ottawa, Ottawa, ON, Canada., So AI; University of British Columbia, Vancouver, BC, Canada., Black PC; University of British Columbia, Vancouver, BC, Canada.
Jazyk: angličtina
Zdroj: Canadian Urological Association journal = Journal de l'Association des urologues du Canada [Can Urol Assoc J] 2018 Aug; Vol. 12 (8), pp. 243-251. Date of Electronic Publication: 2018 Apr 12.
DOI: 10.5489/cuaj.5377
Abstrakt: Introduction: Upper tract urothelial carcinoma (UTUC) accounts for 5% of all urothelial tumours. Due to its rarity, evidence regarding postoperative surveillance is lacking. The objective of this study was to develop a post-radical nephroureterectomy (RNU) surveillance protocol based on recurrence patterns in a large, multi-institutional cohort of patients.
Methods: Retrospective clinical and pathological data were collected from 1029 patients undergoing RNU over a 15-year period (1994-2009) at 10 Canadian academic institutions. A multivariable model was used to identify prognostic clinicopathological factors, which were then used to define risk categories. Risk-based surveillance guidelines were proposed based on actual recurrence patterns.
Results: Overall, 555 (49.9%) patients developed recurrence, including 289 (25.9%) in the urothelium and 266 (23.9%) with loco-regional and distant recurrences. Based on multivariable analysis, three risk groups were identified: 1) low-risk patients with pTa-T1, pN0 disease, and no adverse histological features (high tumour grade, lymphovascular invasion [LVI], tumour multifocality); 2) intermediate-risk patients with pTa-T1, pN0 disease with one or more of the adverse histological features; and 3) high-risk patients with a ≥pT2 tumour and/or nodal involvement. Low-, intermediate-, and high-risk patients were free of urothelial recurrence at three years in 72%, 66%, and 63%, respectively, and free of regional/distant recurrence in 93%, 87%, and 62%, respectively. The risks of loco-regional and distant recurrences (p<0.0001) and time to death (p<0.0001) were significantly different between the low-, intermediate-, and high-risk patients.
Conclusions: Based on recurrence patterns in a large, multicentre patient cohort, we have proposed an evidence-based, risk-adapted post-RNU surveillance protocol.
Databáze: MEDLINE
Externí odkaz: