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Войти в исследования World journal of urology · 2026
Anatomical refinement matters: ureteropelvic junction location confers survival benefit for patients with upper tract urothelial carcinoma after radical nephroureterectomy.
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Guan Bao, Peng Kun, Cao Chao, Du Yicong, Zuo Wei, Han Wencong, Xu Chunru, Zhou Liqun, Li Xuesong, Hao Han
Аннотация
OBJECTIVE: Whether primary tumor location influences prognosis in upper tract urothelial carcinoma (UTUC) remains contentious. We aim to clarify the prognostic impact of tumor location in upper tract urothelial carcinoma (UTUC) by anatomically subsegmenting ureteral tumors, with specific focus on ureteropelvic junction (UPJ) carcinomas.
METHODS: This retrospective cohort study evaluated 2,315 patients with non-metastatic, unifocal UTUC, including tumors localized to the renal pelvis or ureter, who underwent radical nephroureterectomy. Ureteral tumors were rigorously subsegmented into UPJ, proximal/middle/distal ureter, and ureterovesical junction (UVJ) using imaging and clinicopathological data. Survival outcomes-overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), bladder recurrence-free survival (BRFS), and local recurrence-free survival (LRFS)-were evaluated using Kaplan-Meier analysis and Cox proportional hazards models adjusted for clinicopathological confounders.
RESULTS: While univariate analysis showed that compared with renal pelvis tumors, ureteral tumors were associated with worse CSS, OS, MFS, BRFS and LRFS, this association was not independent in multivariable analysis. After conducting a detailed classification of the location of ureteral tumors, we discovered UPJ tumors demonstrated significantly superior OS and CSS compared to other ureteral carcinomas. Critically, UPJ location emerged as an independent predictor of improved OS (HR 0.444; 95% CI 0.240-0.820); p = 0.009) and CSS (HR 0.319; 95% CI 0.130-0.785; p = 0.013) in ureteral carcinoma patients, with the survival advantage most pronounced in muscle-invasive disease.
CONCLUSIONS: Traditional "renal pelvis versus ureter" dichotomy obscures prognostic heterogeneity. Anatomical refinement that recognizes UPJ tumors as a distinct, favorable subset provides a biologically grounded framework for individualized counseling. Furthermore, the recognition of UPJ tumors as a low-risk entity may encourage the investigation of kidney-sparing management strategies in appropriately selected patients.
METHODS: This retrospective cohort study evaluated 2,315 patients with non-metastatic, unifocal UTUC, including tumors localized to the renal pelvis or ureter, who underwent radical nephroureterectomy. Ureteral tumors were rigorously subsegmented into UPJ, proximal/middle/distal ureter, and ureterovesical junction (UVJ) using imaging and clinicopathological data. Survival outcomes-overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), bladder recurrence-free survival (BRFS), and local recurrence-free survival (LRFS)-were evaluated using Kaplan-Meier analysis and Cox proportional hazards models adjusted for clinicopathological confounders.
RESULTS: While univariate analysis showed that compared with renal pelvis tumors, ureteral tumors were associated with worse CSS, OS, MFS, BRFS and LRFS, this association was not independent in multivariable analysis. After conducting a detailed classification of the location of ureteral tumors, we discovered UPJ tumors demonstrated significantly superior OS and CSS compared to other ureteral carcinomas. Critically, UPJ location emerged as an independent predictor of improved OS (HR 0.444; 95% CI 0.240-0.820); p = 0.009) and CSS (HR 0.319; 95% CI 0.130-0.785; p = 0.013) in ureteral carcinoma patients, with the survival advantage most pronounced in muscle-invasive disease.
CONCLUSIONS: Traditional "renal pelvis versus ureter" dichotomy obscures prognostic heterogeneity. Anatomical refinement that recognizes UPJ tumors as a distinct, favorable subset provides a biologically grounded framework for individualized counseling. Furthermore, the recognition of UPJ tumors as a low-risk entity may encourage the investigation of kidney-sparing management strategies in appropriately selected patients.