Royal Derby Hospital, Derby, UK.
BJU Int. 2011 Aug;108(3):406-12. doi: 10.1111/j.1464-410X.2010.09826.x. Epub 2010 Nov 15.
• To compare oncological outcomes in patients undergoing open radical nephroureterectomy (ONU) with those in patients undergoing laparoscopic radical nephroureterectomy (LNU).
• A total of 773 patients underwent radical nephroureterectomy at nine centres worldwide; 703 patients underwent ONU and 70 underwent LNU. • Demographic, perioperative and oncological outcome data were collected retrospectively. • Statistical analysis of data was performed using chi-squared, Mann-Whitney U- and log-rank tests, and Cox regression analyses. • The median (interquartile range) follow-up for the cohort was 34 (15-65) months.
• The two groups were well matched for tumour stage, presence of lymphovascular invasion (LVI) and concomitant carcinoma in situ (CIS). • There were more high-grade tumours (77.1% vs. 56.3%; P < 0.001) but fewer lymph node positive patients (2.9% vs. 6.8%; P= 0.041) in the LNU group. • Estimated 5-year recurrence-free survival (RFS) was 73.7% and 63.4% for the ONU and LNU groups, respectively (P= 0.124) and estimated 5-year cancer-specific survival (CSS) was 75.4% and 75.2% for the ONU and LNU groups, respectively (P= 0.897). • On multivariable analyses, which included age, gender, race, previous endoscopic treatment for bladder cancer, technique for distal ureter management, tumour location, pathological stage, grade, lymph node status, LVI and concomitant CIS, the procedure type (LNU vs. ONU) was not predictive of RFS (Hazard ratio [HR] 0.80; P= 0.534) or CSS (HR 0.96; P= 0.907).
• The present study is the second large, independent, multicentre cohort to show oncological equivalence between ONU and LNU for well selected patients with upper urinary tract urothelial cancer, and the first to suggest parity for the techniques in patients with unfavourable disease.
比较行开放式根治性肾输尿管切除术（ONU）与腹腔镜根治性肾输尿管切除术（LNU）的患者的肿瘤学结果。
全世界 9 个中心共 773 例患者行根治性肾输尿管切除术；703 例行 ONU，70 例行 LNU。回顾性收集人口统计学、围手术期和肿瘤学结果数据。使用卡方检验、Mann-Whitney U 检验和对数秩检验以及 Cox 回归分析对数据进行统计学分析。该队列的中位（四分位距）随访时间为 34（15-65）个月。
两组肿瘤分期、存在脉管侵犯（LVI）和同时存在原位癌（CIS）的情况相匹配。LNU 组中高级别肿瘤的比例更高（77.1%比 56.3%；P<0.001），而淋巴结阳性患者的比例较低（2.9%比 6.8%；P=0.041）。ONU 和 LNU 组的估计 5 年无复发生存率（RFS）分别为 73.7%和 63.4%（P=0.124），估计 5 年癌症特异性生存率（CSS）分别为 75.4%和 75.2%（P=0.897）。多变量分析包括年龄、性别、种族、膀胱癌内镜治疗史、远端输尿管处理技术、肿瘤位置、病理分期、分级、淋巴结状态、LVI 和同时存在 CIS，结果显示手术类型（LNU 与 ONU）与 RFS（风险比 [HR]0.80；P=0.534）或 CSS（HR 0.96；P=0.907）无关。
本研究是第二项大型、独立、多中心队列研究，表明在上尿路尿路上皮癌患者中，ONU 和 LNU 的肿瘤学结果相当，并且首次表明在疾病不利的患者中，两种技术的效果相当。
