Rouprêt Morgan, Hupertan Vincent, Traxer Olivier, Loison Guillaume, Chartier-Kastler Emmanuel, Conort Pierre, Bitker Marc-Olivier, Gattegno Bernard, Richard François, Cussenot Olivier
Department of Urology, Groupe Hospitalo-Universitaire Est, Pitié-Tenon, University Paris VI, Assistance Publique-Hôpitaux de Paris, Paris, France.
Urology. 2006 Jun;67(6):1181-7. doi: 10.1016/j.urology.2005.12.034.
To compare the outcomes in patients who had undergone either open nephroureterectomy or conservative endoscopic surgery (ureteroscopic or percutaneous management) for upper urinary tract transitional cell carcinoma.
We performed a retrospective review of the data for patients treated surgically for upper urinary tract transitional cell carcinoma from 1990 to 2004. The data included patient sex, age at diagnosis, mode of diagnosis, smoking history, history of bladder cancer, type of surgery, complications, and tumor site, size, stage, grade, recurrence, and progression. We also evaluated the recurrence and survival rates.
Data were analyzed for 97 patients. The median patient age was 68 years. Sixteen patients had a history of bladder tumor. The surgical procedure was open nephroureterectomy in 54 patients, ureteroscopy in 27, and percutaneous endoscopic ablation in 16. The tumor stage, grade, and site were independent prognostic factors for survival in a multivariate analysis (P <0.05). The 5-year disease-specific survival rate was 81.9% for low-grade tumors and 47.3% for high-grade tumors (P = 0.0001). A correlation (P = 0.002) was found between low-grade tumors and superficial tumors. In patients with low-grade tumors (n = 46), the 5-year disease-specific survival rate after nephroureterectomy, ureteroscopy, and percutaneous endoscopy was 84%, 80.7%, and 80%, respectively (P = 0.89); the corresponding 5-year tumor-free survival rates were 75.3%, 71.5%, and 72% (P = 0.78).
Conservative surgery can be recommended as an alternative to nephroureterectomy for low-grade or superficial upper urinary tract transitional cell carcinoma. For patients with high-grade or invasive tumors to be candidates for conservative surgery will require the development of additional prognostic factors (eg, molecular markers). These patients require long-term postoperative surveillance.
比较接受开放性肾输尿管切除术或保守性内镜手术（输尿管镜手术或经皮治疗）的上尿路移行细胞癌患者的治疗结果。
我们对1990年至2004年接受手术治疗的上尿路移行细胞癌患者的数据进行了回顾性分析。数据包括患者性别、诊断时年龄、诊断方式、吸烟史、膀胱癌病史、手术类型、并发症以及肿瘤部位、大小、分期、分级、复发和进展情况。我们还评估了复发率和生存率。
对97例患者的数据进行了分析。患者中位年龄为68岁。16例患者有膀胱肿瘤病史。手术方式为开放性肾输尿管切除术54例，输尿管镜手术27例，经皮内镜消融术16例。在多因素分析中，肿瘤分期、分级和部位是生存的独立预后因素（P<0.05）。低级别肿瘤的5年疾病特异性生存率为81.9%，高级别肿瘤为47.3%（P=0.0001）。低级别肿瘤与浅表性肿瘤之间存在相关性（P=0.002）。在低级别肿瘤患者（n=46）中，肾输尿管切除术后、输尿管镜手术后和经皮内镜检查后的5年疾病特异性生存率分别为84%、80.7%和80%（P=0.89）；相应的5年无瘤生存率分别为75.3%、71.5%和72%（P=0.78）。
对于低级别或浅表性上尿路移行细胞癌，可推荐保守性手术作为肾输尿管切除术的替代方案。对于高级别或浸润性肿瘤患者，若要成为保守性手术的候选者，需要开发更多的预后因素（如分子标志物）。这些患者术后需要长期监测。
