Haddad Mattieu, Cloutier Jonathan, Cornu Jean Nicolas, Villa Luca, Terrasa Jean-Baptiste, Benbouzid Sabrina, Audouin Marie, Cussenot Olivier, Traxer Olivier
Department of Urology, Tenon Hospital , Paris, France .
J Endourol. 2015 Aug;29(8):969-73. doi: 10.1089/end.2015.0044. Epub 2015 Jun 18.
Conservative treatment (CT) with flexible ureteroscopy and laser ablation is an alternative to radical nephroureterectomy (RNU) for the treatment of the upper urinary tract urothelial carcinoma (UTUC). The purpose of this study was to compare the pathology results obtained after immediate RNU or after attempt of CT for elective indication.
A retrospective study was conducted in a single tertiary center. All patients who had an RNU for urothelial carcinoma between 2007 and 2012 have been included. The patients were classified into two groups: group 1 is immediate RNU, and group 2 is RNU after CT (only elective indications). Preoperative data collected were as follows: age, sex, chronic kidney failure, radiological classification for cancer staging (TNM), tumor size, localization, and multifocal indication of CT. The pathological RNU data collected were tumor stage and grade. The T stage was divided into two groups (primary endpoint): pTa-T1-T2 and pT3-T4. The χ(2) test and Mann-Whitney was performed to compare the independent qualitative and quantitative variables, respectively.
A total of 51 patients were included (40 patients in the immediate RNU group and 11 patients in the delayed RNU group after CT). Patients in both groups had comparable characteristics regarding age, sex, location, T stage, and preoperative tumor grade. On final pathology, 23 tumors were classified as pTa-T1-T2 in the immediate RNU group compared with 6 in the delayed RNU group. Seventeen and five tumors were classified as T3 in group 1 and group 2, respectively. These results were not significantly different between both groups (p=0.866). The pathological RNU grade was not significantly different between the groups.
Within the limits of this retrospective study, the pathological RNU data showed no significant difference when RNU was done immediately or after CT for UTUC.
对于上尿路尿路上皮癌（UTUC）的治疗，采用软性输尿管镜和激光消融的保守治疗（CT）是根治性肾输尿管切除术（RNU）的一种替代方案。本研究的目的是比较择期适应症在立即行RNU或尝试CT治疗后获得的病理结果。
在单一的三级中心进行了一项回顾性研究。纳入了2007年至2012年间因尿路上皮癌行RNU的所有患者。患者被分为两组：第1组为立即行RNU，第2组为CT后行RNU（仅择期适应症）。收集的术前数据如下：年龄、性别、慢性肾衰竭、癌症分期的放射学分类（TNM）、肿瘤大小、位置以及CT的多灶性适应症。收集的RNU病理数据为肿瘤分期和分级。T分期分为两组（主要终点）：pTa-T1-T2和pT3-T4。分别采用χ²检验和曼-惠特尼检验来比较独立的定性和定量变量。
共纳入51例患者（立即行RNU组40例，CT后延迟行RNU组11例）。两组患者在年龄、性别、位置-T分期和术前肿瘤分级方面具有可比的特征。最终病理检查显示，立即行RNU组有23个肿瘤被分类为pTa-T1-T2，而延迟行RNU组为6个。第1组和第2组分别有17个和5个肿瘤被分类为T3。两组之间这些结果无显著差异（p = 0.866）。两组之间RNU病理分级无显著差异。
在本回顾性研究的范围内，对于UTUC，立即行RNU或CT后行RNU时，RNU病理数据无显著差异。
