Department of Urology, Hôpital Claude Huriez, CHRU Lille, Rue Michel Polonovski, 59037, Lille, France.
World J Urol. 2013 Feb;31(1):69-76. doi: 10.1007/s00345-012-0959-1. Epub 2012 Oct 16.
According to the current upper urinary tract urothelial carcinomas (UTUC) guidelines, ureteroscopic evaluation (URS) is recommended to improve diagnostic accuracy and obtain a grade (by biopsy or cytology). However, URS may delay radical surgery [e.g., nephroureterectomy (RNU)]. The objective of this study was to evaluate the influence of URS implementation before RNU on patient survival.
A French multicentre retrospective study including 512 patients with nonmetastatic UTUC was conducted between 1995 and 2011. Achievement of ureteroscopy (URS), treatment time (time between imaging diagnosis and RNU), tumour location, pT-pN stage, grade, lymphovascular invasion (LVI) and the presence of invaded surgical margins (R+) were evaluated as prognostic factors for survival using univariate and multivariate Cox regression analyses. Cancer-specific survival (CSS), recurrence-free survival (RFS) and metastasis-free survival (MFS) were calculated using the Kaplan-Meier method.
A total of 170 patients underwent ureteroscopy prior to RNU (URS+ group), and 342 did not undergo URS (URS-). The median treatment time was significantly longer in the URS+ group (79.5 vs. 44.5 days, p = 0.04). Ureteroscopic evaluation was correlated with ureteral location and lower stage and tumour grade (p = 0.022, 0.005, 0.03, respectively). Tumour stage, LVI+ and R+ status were independently associated with CSS (p = 0.024, 0.049 and 0.006, respectively). The 5-year CSS, RFS and MFS did not differ between the two groups (p = 0.23, 0.89 and 0.35, respectively). These results were confirmed for muscle-invasive (MI) UTUC (p = 0.21, 0.44 and 0.67 for CSS, RFS and MFS, respectively).
Despite the increased time to radical surgery, diagnostic ureteroscopy can be systematically performed for the appraisal of UTUC to refine the therapeutic strategy without significantly affecting oncological outcomes, even for MI lesions.
根据当前上尿路尿路上皮癌（UTUC）指南，推荐行输尿管镜检查（URS）以提高诊断准确性并获得分级（通过活检或细胞学检查）。然而，URS 可能会延迟根治性手术[例如，肾输尿管切除术（RNU）]。本研究旨在评估 RNU 前行 URS 对患者生存的影响。
本研究为 1995 年至 2011 年期间开展的一项法国多中心回顾性研究，共纳入 512 例非转移性 UTUC 患者。评估输尿管镜检查的实施情况（URS）、治疗时间（影像学诊断与 RNU 之间的时间）、肿瘤位置、pT-pN 分期、分级、脉管侵犯（LVI）和有侵袭性的手术切缘（R+），采用单因素和多因素 Cox 回归分析这些因素与生存的关系。采用 Kaplan-Meier 法计算癌症特异性生存率（CSS）、无复发生存率（RFS）和无转移生存率（MFS）。
共有 170 例患者在 RNU 前行 URS（URS+组），342 例患者未行 URS（URS-组）。URS+组的中位治疗时间明显长于 URS-组（79.5 天比 44.5 天，p=0.04）。URS 与输尿管位置和较低的分期及肿瘤分级相关（p=0.022、0.005、0.03）。肿瘤分期、LVI+和 R+状态与 CSS 独立相关（p=0.024、0.049 和 0.006）。两组患者的 5 年 CSS、RFS 和 MFS 无差异（p=0.23、0.89 和 0.35）。这些结果在肌肉浸润性（MI）UTUC 中得到了证实（CSS、RFS 和 MFS 的 p 值分别为 0.21、0.44 和 0.67）。
尽管根治性手术的时间延长，但为评估 UTUC 而行诊断性 URS 可系统地进行，以细化治疗策略，而不会显著影响肿瘤学结局，即使对于 MI 病变也是如此。
