Krabbe Laura-Maria, Westerman Mary E, Bagrodia Aditya, Gayed Bishoy A, Khalil Dina, Kapur Payal, Shariat Shahrokh F, Raj Ganesh V, Sagalowsky Arthur I, Cadeddu Jeffrey A, Lotan Yair, Margulis Vitaly
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, University of Muenster Medical Center, Muenster, Germany.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
Urol Oncol. 2014 Jan;32(1):54.e19-26. doi: 10.1016/j.urolonc.2013.08.032.
To evaluate the effect of distal ureter management on oncological outcomes in patients with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma.
Retrospective review of patient records and operative reports was conducted on 122 patients who underwent RNU. Data were compared between 2 groups using substratification by distal ureter management (transvesical bladder cuff [TVBC]) vs. no TVBC).
Mean patient age was 69.0 years and 63.1% were male. Median follow-up was 32.0 months. Most patients (n = 76, 62.3%) received a TVBC and 46 (37.7%) patients received no TVBC during RNU. There were no significant differences in clinicopathological variables between both groups except for a higher rate of lymphadenectomy during surgery in the TVBC group (38.2% vs. 15.2%). On multivariate analysis, intravesical recurrence (IVR) was not affected by distal ureter management but was affected by tumor multifocality (hazard ratio [HR] = 2.2; 95% confidence interval [CI], 1.2-4.0; P = 0.013). However, non-IVR-free survival (non-IVR FS) and cancer-specific survival (CSS) were independently influenced by T stage (HR = 4.9; 95% CI, 1.5-16.3; P = 0.010 for non-IVR FS and HR = 6.3; 95% CI, 1.7-23.1; P = 0.005 for CSS) and management of the distal ureter (HR = 3.2; 95% CI, 1.3-7.6; P = 0.010 for non-IVR FS and HR = 3.4; 95% CI, 1.3-8.8; P = 0.010 for CSS).
In our study, surgical management of the distal ureter without excision of a TVBC resulted in significantly worse non-IVR FS and CSS but had no influence on IVR. This is hypothesis generating and supports further prospective study as to standardization of BC resection during RNU.
评估根治性肾输尿管切除术（RNU）治疗上尿路尿路上皮癌时远端输尿管处理方式对肿瘤学结局的影响。
对122例行RNU手术的患者的病历和手术报告进行回顾性分析。根据远端输尿管处理方式（经膀胱膀胱袖套状切除术[TVBC]）与未行TVBC）进行亚分层，比较两组数据。
患者平均年龄为69.0岁，男性占63.1%。中位随访时间为32.0个月。大多数患者（n = 76，62.3%）在RNU手术期间接受了TVBC，46例（37.7%）患者未接受TVBC。两组间临床病理变量无显著差异，但TVBC组手术期间淋巴结清扫率较高（38.2%对15.2%）。多因素分析显示，膀胱内复发（IVR）不受远端输尿管处理方式的影响，但受肿瘤多灶性影响（风险比[HR]=2.2；95%置信区间[CI]，1.2 - 4.0；P = 0.013）。然而，无IVR生存期（non-IVR FS）和癌症特异性生存期（CSS）分别独立受T分期（non-IVR FS的HR = 4.9；95% CI，1.5 - 16.3；P = 0.010，CSS的HR = 6.3；95% CI，1.7 - 23.1；P = 0.005）和远端输尿管处理方式影响（non-IVR FS的HR = 3.2；95% CI，1.3 - 7.6；P = 0.010，CSS的HR = 3.4；95% CI，1.3 - 8.8；P = 0.010）。
在我们的研究中，未切除TVBC的远端输尿管手术处理导致non-IVR FS和CSS显著更差，但对IVR无影响。这仅为假设，支持进一步开展关于RNU手术中膀胱袖套状切除术标准化的前瞻性研究。
