urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.23.4.104TSXIWNurmj-1580Research ArticleОригинальные статьи | Original articlesOriginal articlesВлияние немышечно-инвазивного рецидива уротелиального рака верхних мочевых путей на выживаемость пациентов после радикальной нефруретерэктомииThe Impact of Non-Muscle-Invasive Recurrence of Upper Tract Urothelial Carcinoma on The Survival of Patients After Radical Nephroureterectomyhttps://orcid.org/0009-0002-2359-8351ОрловА. С.OrlovA. S.

Александр Сергеевич Орлов — онколог отделения онкоурологии

Екатеринбург

Alexander S. Orlov — Oncologist of the Department of Oncourology

Ekaterinburg

orlovsood@yandex.ruhttps://orcid.org/0000-0002-6813-4457МагерВ. О.MagerV. O.

Владимир Остапович Магер — кандидат медицинских наук, заведующий отделения онкоурологии

Екатеринбург

Vladimir O. Mager — Candidate of Sciences (Medicine), Head of the Department of Oncourology

Ekaterinburg

senior.mager@yandex.ruhttps://orcid.org/0009-0004-9957-0050ЩегловаВ. П.ShcheglovaV. P.

Варвара Петровна Щеглова — онколог отделения онкоурологии

Екатеринбург

Varvara P. Shcheglova — Oncologist of the Department of Oncourology

Ekaterinburg

scheglovavp@gmail.comhttps://orcid.org/0009-0005-5960-9958КоваленкоД. А.KovalenkoD. A.

Дмитрий Анатольевич Коваленко — онколог отделения онкоурологии

Екатеринбург

Dmitry A. Kovalenko — Oncologist of the Department of Oncourology

Ekaterinburg

kovalenko.sood@gmail.comhttps://orcid.org/0009-0001-2472-4914СорочкинД. А.SorochkinD. A.

Дмитрий Александрович Сорочкин — онколог отделения онкоурологии

Екатеринбург

Dmitry A. Sorochkin — Oncologist of the Department of Oncourology

Ekaterinburg

sorochkin.urologist@gmail.comhttps://orcid.org/0009-0004-5789-4532ИвановС. Э.IvanovS. E.

Станислав Эдуардович Иванов — онколог отделения онкоурологии

Екатеринбург

Stanislav E. Ivanov — Oncologist of the Department of Oncourology

Ekaterinburg

stanislavvv3579@gmail.comСвердловский областной онкологический диспансерРоссияSverdlovsk Regional Oncology CenterRussian Federation202403092024234Специальный выпуск «Онкология»104–115Copyright © Орлов А.С., Магер В.О., Щеглова В.П., Коваленко Д.А., Сорочкин Д.А., Иванов С.Э., 20242024Орлов А.С., Магер В.О., Щеглова В.П., Коваленко Д.А., Сорочкин Д.А., Иванов С.Э.Orlov A.S., Mager V.O., Shcheglova V.P., Kovalenko D.A., Sorochkin D.A., Ivanov S.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1580Введение

Введение. После выполненной радикальной нефруретерэктомии по поводу уротелиального рака верхних мочевых путей (УРВМП) 15–50 % пациентов имеют рецидив УРВМП в мочевом пузыре. Немышечно-инвазивный рецидив (НМИР) УРВМП в мочевом пузыре встречается в 80–90 % случаев от всех типов рецидивов УРВМП.

Цель работы — изучить влияние НМИР на выживаемость пациентов после радикальной нефруретерэктомии, оценить характеристики первичной опухоли и ее влияние на появление НМИР.

Материалы и методы

Материалы и методы. 157 пациентов подвергнуты хирургическому лечению по поводу УРВМП за период с 2011 по 2021 г. Проанализирована общая (ОВ), беспрогрессивная (БПВ), раковоспецифическая (РСВ) выживаемость у пациентов с наличием и отсутствием НМИР. Регрессионный анализ Кокса использован для оценки риска возникновения НМИР.

Результаты

Результаты. НМИР отмечен у 32 пациентов (20,4 %). 5-летняя ОВ, РСВ и БПВ пациентов с НМИР оказалась выше, чем в группе пациентов без наличия НМИР, и составила 92,4 %, 96,6 %, 93,4 % против 61,4 %, 74,9 %, 68,9 % соответственно. При сравнении клинических и патоморфологических характеристик выявлено, что первичная опухоль G3, местно-распространенный характер процесса достоверно реже встречаются в группе НМИР, при этом сопутствующий рак мочевого пузыря, одномоментное поражение опухолью лоханки и мочеточника, а также немышечно-инвазивный характер первичной опухоли достоверно чаще встречаются в группе НМИР. По данным многофакторного регрессионного анализа, установлено, что риск возникновения НМИР увеличивается в 2 раза при одномоментном поражении опухолью лоханки и мочеточника (ОР — 2,93; 95 % ДИ — 1,43–7,13; p = 0,005) и сопутствующем раке мочевого пузыря (ОР — 2,89; 95 % ДИ — 1,01–6,11; p = 0,035).

Заключение

Заключение. Выявлены достоверно лучшие показатели выживаемости пациентов с УРВМП при наличии НМИР. У пациентов с НМИР достоверно реже встречаются агрессивные формы первичной опухоли и местно-распространенный характер заболевания.

Introduction

Introduction. After radical nephroureterectomy for the upper tract urothelial carcinoma (UTUC), 15–50 % of patients have a relapse in the bladder. Non-muscle invasive relapse in the bladder (NMIR) occurs in 80–90 % of all types of bladder relapses.

The purpose of the study is to evaluate the effect of NMIR on patient survival after RNUE, and study the characteristics of the primary tumor and its effect on the occurrence of NMIR.

Materials and methods

Materials and methods. 157 patients underwent surgical treatment for UTUC during the period from 2011 to 2021. Overall (OS), progressive free (PFS), and cancer-specific (CSS) survival in patients with a relapse in the bladder was analyzed. Cox regression analysis was used to estimate the risk of NMIR.

Results

Results. NMIR was observed in 32 patients (20.4 %). 5‑year OS, PFS and CSS of patients with NMIR was higher than in the group of patients without NMIR and amounted to 92.4 %, 96.6 %, 93.4 % versus 61.4 %, 74.9 %, 68.9 % respectively. When comparing the clinical and pathomorphological characteristics, it was found that the primary tumor G3, locally advanced tumor are significantly less common in the NMIRC group, while concomitant bladder cancer, simultaneous lesion of the renal pelvis and ureter, as well as non-muscle-invasive cancer are significantly more common in the NMIRC group. According to the multivariate regression analysis, the risk of NMIRC increases by 2 times with simultaneous tumor lesion of the renal pelvis and ureter (HR — 2.93; 95 % CI — 1.43–7.13; p = 0.005) and concomitant bladder cancer (HR — 2.89; 95 % CI — 1.01–6.11; p = 0.035).

Conclusion

Conclusion. Significantly better survival rates were found for patients with UTUC in the presence of NMIR. Patients with NMIR are significantly less common to have aggressive forms of the primary tumor and a locally advanced disease.

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The authors declare that there are no conflicts of interest present.