Factores predictivos de neoplasia vesical metacrónica tras nefroureterectomía

Resumen

Objetivo

Determinar factores pronosticos de recidiva vesical en pacientes con carcinoma urotelial del tracto urinario superior (TUS), tratados mediante nefroureterectomia.

Material y métodos

Pacientes (N=51) con carcinoma de celulas transicionales del TUS tratados mediante nefroureterectomia. Se realizo un estudio observacional de cohorte retrospectivo y prospectivo durante el periodo 1995-2007, en el Hospital Arquitecto Marcide, Area Sanitaria de Ferrol, La Coruna. Se analizaron las diferencias entre grupos con y sin recidiva vesical mediante test chi-cuadrado en variables cualitativas y test t-Student y U Mann-Whitney en variables cuantitativas. Se estudio la supervivencia libre de recidiva vesical (SLRV) mediante la metodologia de Kaplan-Meier, desarrollando un modelo multivariado de regresion de Cox para identificar variables asociadas a recidiva vesical.

Resultados

La media de edad fue 68,51-12,11 anos (24-86). La distribucion por grado histologico fue la siguiente: 7 g1 (13,72%), 20 g2 (39,21%), 23 g3 (45,10%) y 1 caso indeterminado (1,97%). En cuanto a la categoria pt, 19 casos eran pt1 (37,25%), 12 pt2 (23,53%), 19 pt3 (37,25%) y 1 caso indeterminado (1,97%). Durante el seguimiento se detecto recidiva vesical en 16 pacientes (31,37%). El 70,59% de las recidivas se identificaron durante los dos primeros anos de seguimiento. Entre los pacientes sin y con recidiva vesical se detectaron diferencias relacionadas con tiempo de seguimiento, existencia de uropatia obstructiva, morfologia microscopica y multifocalidad tumoral. La SLRV al cabo de 1, 2, 5 y 10 anos fue del 85,10%, 67,90%, 56,60% y 31,80%, respectivamente. La SLRV se modifico significativamente en funcion de la localizacion (p=0,019) y la multifocalidad (p=0,002) tumorales. En el analisis multivariado se observo que la multifocalidad tumoral predecia de forma independiente la recidiva vesical (rr=7,35;95%ic=1,57-34,45;p=0,011).

Conclusiones

El desarrollo de recidiva vesical tras nefroureterectomia se observa en el 31,37% del los pacientes de nuestro estudio, detectandose la mayoria de los episodios durante los dos primeros anos de seguimiento. La multifocalidad tumoral en el TUS es el factor de riesgo mas importante para el desarrollo de recidiva vesical.

Abstract

Purpose

To determine prognostic factors of bladder recurrence in patients with upper urinary tract (UUT) urothelial carcinoma, who underwent nephroureterectomy.

Material and methods

Patients (N=51) with UUT transitional cell carcinoma who underwent nephroureterectomy. A Retrospective and prospective observational cohort study was made during the period 1995-2007, at Arquitecto Marcide Hospital, Ferrol Health Area, La Coruna. Differences between groups with and without recurrence were analized by means of chi-squared test in qualitative variables and t-Student and U Mann-Whitney test in quantitative variables. Kaplan-Meier methodology was used in order to predict bladder recurrence free survival (BRFS), developing a multivariate Cox regression model to identify variables related to bladder recurrence.

Results

Mean age of patients was 68.51-12.11 (24-86). Histological grade distribution was as follows: 7 g1 (13.72%), 20 g2 (39.21%), 23 g3 (45.10%) and 1 undetermined case(1.97%). With regard to pT category, 19 cases were pt1(37.25%), 12 pt2 (23.53%), 19 pt3 (37.25%) y 1 case undetermined (1.97%). Bladder recurrence was detected in 16 patients during follow-up (31.37%). 70.59% of recurrences were identified during first two years of follow-up. Differences related to follow-up period, presence of obstructive uropathy, microscopic growth pattern and tumour multifocality, were observed between patients without and with bladder recurrence. BRFS rates at 1, 2, 5 and 10 years were 85.10%, 67.90%, 56.60% y 31.80%, respectively. BRFS was significantly modified by tumour location (p=0.019) and tumour multifocality (p=0.002). Multivariate analysis showed that tumour multifocality was an independent factor in the prediction of bladder recurrence (rr=7.35;95%ci=1.57-34.45;p=0.011).

Conclusions

The development of bladder recurrence after nephroureterectomy was observed in 31.37% of patients in our study, detecting most of events during the first two years of follow-up. Tumour multifocality in UUT constitutes the most important risk factor for the development of bladder recurrence.