Department of Urology, Medical University of Graz, Graz, Austria.
Department of Urology, Medical University of Graz, Graz, Austria.
Urol Oncol. 2014 Jan;32(1):34.e1-8. doi: 10.1016/j.urolonc.2013.01.001. Epub 2013 Mar 15.
We evaluated cancer-specific survival (CSS) and recurrence-free survival (RFS) rates of open distal ureterectomy (DU) compared with radical nephroureterectomy (RNU) for urothelial carcinoma of the distal ureter.
We retrospectively considered patients with urothelial carcinoma of the distal ureter who underwent DU or RNU at our department. Survival analysis and Cox regression models compared CSS and RNU after DU and RNU. RFS was evaluated separately for bladder and upper tract. Covariates were age, gender, symptoms at diagnosis, pathologic stage and grade, associated carcinoma in situ, surgical margins, lympho-vascular invasion, multifocality, necrosis, and previous or concomitant bladder cancer.
Forty-nine and 42 patients underwent DU and RNU, respectively. Median patients' follow-up was 51.5 months (range 4-290 mo). Two patients (4%) in the DU group were diagnosed with a recurrence in the ipsilateral upper tract after 63 and 45 months, respectively. Both patients underwent nephroureterectomy and are still alive in strict follow-up for non-muscle invasive bladder recurrence. Contralateral upper tract recurrence was observed in 1 and 3 patients in the RNU and DU group, respectively. At 5 years, CSS and RFS (upper tract) rates were 77% and 91% for DU and 78% and 96% for RNU, respectively. On univariable and multivariable analyses the type of surgery did not influence CSS and RFS (P = 0.92 and P = 0.94).
DU is a safe surgical option in patients with urothelial carcinoma of the distal ureter and does not compromise oncologic outcomes compared with RNU.
我们评估了开放远端输尿管切除术（DU）与根治性肾输尿管切除术（RNU）治疗输尿管远端尿路上皮癌的肿瘤特异性生存率（CSS）和无复发生存率（RFS）。
我们回顾性分析了在我院接受 DU 或 RNU 治疗的输尿管远端尿路上皮癌患者。生存分析和 Cox 回归模型比较了 DU 和 RNU 后的 CSS 和 RFS。分别评估膀胱和上尿路的 RFS。协变量包括年龄、性别、诊断时的症状、病理分期和分级、合并原位癌、手术切缘、淋巴血管侵犯、多灶性、坏死和先前或同时存在的膀胱癌。
49 例患者接受 DU，42 例患者接受 RNU。中位随访时间为 51.5 个月（范围 4-290 个月）。DU 组有 2 例（4%）患者在术后 63 和 45 个月分别在同侧上尿路诊断为复发。这两名患者均接受了肾输尿管切除术，并在严格随访中未发现肌层浸润性膀胱癌复发。RNU 和 DU 组分别有 1 例和 3 例患者出现对侧上尿路复发。在 5 年时，DU 组的 CSS 和 RFS（上尿路）分别为 77%和 91%，RNU 组分别为 78%和 96%。单变量和多变量分析显示手术类型对 CSS 和 RFS 没有影响（P = 0.92 和 P = 0.94）。
在输尿管远端尿路上皮癌患者中，DU 是一种安全的手术选择，与 RNU 相比，不会影响肿瘤学结果。
