Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.
J Urol. 2010 Apr;183(4):1324-9. doi: 10.1016/j.juro.2009.12.018. Epub 2010 Feb 19.
To date no study to our knowledge has compared cancer control outcomes of segmental ureterectomy relative to nephroureterectomy, which represents the standard of care for ureteral transitional cell carcinoma. We compared cancer specific mortality rates according to surgery type (nephroureterectomy vs segmental ureterectomy) in a large population based cohort of patients with ureteral transitional cell carcinoma.
Our analyses involved 2,044 patients with pathological T1-T4 N0M0 ureteral transitional cell carcinoma from the Surveillance, Epidemiology and End Results database. Survival plots and Cox regression models compared cancer specific mortality after segmental ureterectomy, or nephroureterectomy with or without bladder cuff removal. Covariates consisted of pathological stage and grade, age, race, gender and year of surgery.
Median followup of censored patients was 30.0 months. Overall 569 (27.8%) patients underwent segmental ureterectomy vs 1,222 (59.8%) nephroureterectomy with bladder cuff removal and 253 (12.4%) nephroureterectomy without bladder cuff removal. At 5 years cancer specific mortality-free rates for segmental ureterectomy vs nephroureterectomy with bladder cuff removal vs nephroureterectomy without bladder cuff removal were 86.6% vs 82.2% vs 80.5%, respectively (all pairwise log rank comparisons p >or=0.05). On univariable and multivariable analyses of the entire cohort, as well as after stratification according to pT1-2 vs pT3-4 stage, the type of surgery (segmental ureterectomy vs nephroureterectomy with bladder cuff removal vs nephroureterectomy without bladder cuff removal) failed to affect cancer specific mortality rates (p >or=0.2).
In patients with ureteral transitional cell carcinoma segmental ureterectomy does not undermine cancer control outcomes relative to nephroureterectomy (with or without bladder cuff removal). Therefore, segmental ureterectomy may be offered to virtually all patients with ureteral transitional cell carcinoma when it is technically feasible, which also includes carefully selected patients with T3 or even T4 lesions.
目前为止，据我们所知，还没有研究比较过针对输尿管移行细胞癌的节段性输尿管切除术与肾输尿管切除术的肿瘤控制结果，后者是输尿管移行细胞癌的标准治疗方法。我们比较了大样本基于人群的输尿管移行细胞癌患者的手术类型（肾输尿管切除术与节段性输尿管切除术）与癌症特异性死亡率。
我们的分析涉及 Surveillance，Epidemiology and End Results 数据库中 2044 例病理 T1-T4 N0M0 输尿管移行细胞癌患者。生存图和 Cox 回归模型比较了节段性输尿管切除术与肾输尿管切除术（带或不带膀胱袖套切除）后癌症特异性死亡率。协变量包括病理分期和分级、年龄、种族、性别和手术年份。
对有 censored 患者的中位随访时间为 30.0 个月。总的来说，569 例（27.8%）患者接受了节段性输尿管切除术，1222 例（59.8%）接受了带膀胱袖套切除的肾输尿管切除术，253 例（12.4%）接受了不带膀胱袖套切除的肾输尿管切除术。在 5 年时，节段性输尿管切除术与带膀胱袖套切除的肾输尿管切除术与不带膀胱袖套切除的肾输尿管切除术相比，癌症特异性死亡率无复发生存率分别为 86.6%、82.2%和 80.5%（所有两两对数秩检验比较均 p≥0.05）。在整个队列的单变量和多变量分析中，以及根据 pT1-2 与 pT3-4 分期进行分层后，手术类型（节段性输尿管切除术与带膀胱袖套切除的肾输尿管切除术与不带膀胱袖套切除的肾输尿管切除术）均未影响癌症特异性死亡率（p≥0.2）。
在输尿管移行细胞癌患者中，节段性输尿管切除术并不影响肿瘤控制结果，与肾输尿管切除术（带或不带膀胱袖套切除）相比。因此，在技术上可行的情况下，几乎所有输尿管移行细胞癌患者都可以采用节段性输尿管切除术，包括精心选择的 T3 甚至 T4 病变患者。
