Fang Chen, Xie Xin, Xu Tianyuan, He Wei, He Hongchao, Wang Xiaojing, Zhu Yu, Shen Zhoujun, Shao Yuan
Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, No. 197, 2nd Ruijin Road, Shanghai, 200025, China.
Department of Urology, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Int Urol Nephrol. 2017 Jul;49(7):1177-1182. doi: 10.1007/s11255-017-1576-0. Epub 2017 Mar 25.
To evaluate oncologic outcomes of segmental ureterectomy (SU) compared with radical nephroureterectomy (RNU) for urothelial carcinoma of ureter. To evaluate whether tumor position is a factor to influence outcomes of different surgical procedures.
From November 2003 to June 2016, 131 patients with urothelial carcinoma of ureter underwent SU or RNU at our department. We used survival analysis and Cox regression models to compare oncologic outcomes after SU and RNU. Covariates included surgical type, tumor stage, cancer grade, lesion position, presence of preoperative hydronephrosis and histories of bladder cancer. Patients were divided according to lesion sites for further comparison.
The mean length of follow-up was 55.3 and 50.9 months for the RNU and SU group, respectively. The bladder recurrences, local recurrences, distant metastasis, cancer-specific survival and overall survival rates showed no significant differences between RNU and SU (p = 0.596, p = 0.636, p = 0.740, p = 0.809, p = 0.553, respectively). For mid-ureter or distal ureter lesions, no significant difference of oncologic outcomes between SU and RUN was observed.
Our study suggested SU is not inferior to RNU for either middle or distal ureter urothelial cell carcinomas.
评估输尿管节段性切除术（SU）与根治性肾输尿管切除术（RNU）治疗输尿管尿路上皮癌的肿瘤学结局。评估肿瘤位置是否为影响不同手术方式结局的因素。
2003年11月至2016年6月，131例输尿管尿路上皮癌患者在我科接受了SU或RNU手术。我们采用生存分析和Cox回归模型比较SU和RNU术后的肿瘤学结局。协变量包括手术类型、肿瘤分期、癌症分级、病变位置、术前肾积水情况及膀胱癌病史。根据病变部位对患者进行分组以作进一步比较。
RNU组和SU组的平均随访时间分别为55.3个月和50.9个月。RNU组和SU组之间的膀胱复发、局部复发、远处转移、癌症特异性生存率和总生存率均无显著差异（分别为p = 0.596、p = 0.636、p = 0.740、p = 0.809、p = 0.553）。对于输尿管中段或下段病变，SU和RNU之间的肿瘤学结局无显著差异。
我们的研究表明，对于输尿管中段或下段尿路上皮细胞癌，SU并不逊色于RNU。
