Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
J Urol. 2017 Dec;198(6):1278-1285. doi: 10.1016/j.juro.2017.06.073. Epub 2017 Jun 17.
Since conditional survival analysis provides better estimates of survival time at each followup, we assessed changes in conditional intravesical recurrence-free survival rates after radical nephroureterectomy. We also sought to determine how the impact of well-known risk factors evolves with time, particularly in patients with localized upper tract urothelial carcinoma.
We identified 364 patients with Ta-3N0M0 localized upper tract urothelial carcinoma who underwent open or laparoscopic radical nephroureterectomy at 1 of our 3 institutions. Conditional intravesical recurrence-free and cancer specific survival rates were calculated using the Kaplan-Meier method. The changing impact of parameters on intravesical recurrence with time was assessed by multivariate Cox regression analysis.
Intravesical recurrence after radical nephroureterectomy was detected in 176 patients (48.4%) and 93 (25.5%) died of localized upper tract urothelial carcinoma. Five-year intravesical recurrence-free and cancer specific survival rates after surgery were 41.5% and 72.9%, respectively. Based on 1, 2, 3 and 4-year survivorship the 5-year conditional intravesical recurrence-free survival rate increased from 41.5% to 60.5%, 73.4%, 79.5% and 96.7%, respectively. The 5-year conditional cancer specific survival rate also improved from 72.9% to 78.4%, 85.4%, 90.9% and 95.5% at 1, 2, 3 and 4 years, respectively. The effects of well-known predictive factors on estimated conditional survival decreased with time for intravesical recurrence. In contrast, the impact of T2 or lower pathological stage and laparoscopic radical nephroureterectomy sustained statistical power with time.
Conditional survival analysis revealed that the probability of intravesical recurrence-free survival increased with time in patients with localized Ta-3N0M0 upper tract urothelial carcinoma after radical nephroureterectomy. Patients with T2 or lower T stage who undergo laparoscopic radical nephroureterectomy may be recommended for longer followup to detect subsequent intravesical recurrence.
由于条件生存分析可以更好地估计每次随访时的生存时间，因此我们评估了根治性肾输尿管切除术（radical nephroureterectomy）后，条件性膀胱内无复发生存率的变化情况。我们还试图确定在时间推移的情况下，哪些已知的危险因素的影响会发生变化，尤其是在患有局限性上尿路上皮癌的患者中。
我们在 3 家医疗机构中的 1 家，识别了 364 名 Ta-3N0M0 局限性上尿路上皮癌患者，他们接受了开放性或腹腔镜根治性肾输尿管切除术。使用 Kaplan-Meier 法计算条件性膀胱内无复发生存率和癌症特异性生存率。通过多变量 Cox 回归分析评估参数对随时间推移的膀胱内复发的影响变化。
在 176 名患者（48.4%）中检测到根治性肾输尿管切除术后的膀胱内复发，93 名（25.5%）患者死于局限性上尿路上皮癌。手术后 5 年的膀胱内无复发生存率和癌症特异性生存率分别为 41.5%和 72.9%。基于 1、2、3 和 4 年的生存率，5 年的条件性膀胱内无复发生存率从 41.5%增加到 60.5%、73.4%、79.5%和 96.7%。5 年的条件性癌症特异性生存率也从 72.9%增加到 78.4%、85.4%、90.9%和 95.5%，分别在 1、2、3 和 4 年。已知预测因素对估计条件生存的影响随着时间的推移而降低，而膀胱内复发的 T2 或更低病理分期和腹腔镜根治性肾输尿管切除术的影响则随着时间的推移保持了统计学效力。
条件生存分析显示，在接受根治性肾输尿管切除术的 Ta-3N0M0 局限性上尿路上皮癌患者中，膀胱内无复发生存率的概率随着时间的推移而增加。接受腹腔镜根治性肾输尿管切除术且 T2 或更低 T 分期的患者，可能需要进行更长时间的随访，以检测随后的膀胱内复发。
