Strijbos Willem E, van der Heij Bart
Department of Urology, Zuyderland Medical Centre, Heerlen, The Netherlands.
Asian J Urol. 2016 Jul;3(3):134-141. doi: 10.1016/j.ajur.2016.04.003. Epub 2016 May 27.
In the management of upper tract urothelial cell carcinoma (UTUC) endoscopic, nephron sparing procedures like ureterorenoscopy (URS) or percutaneous tumour resection (PCTR) still play a very limited role. This could lead to possible unnecessary radical nephroureterectomies (RNU), still being the gold standard treatment. The risk of chronic kidney disease (CKD) later in life is important. In this study we present the results of 24-year experience with PCTR in a single institution.
We identified 44 patients who underwent PCTR between 1992 and 2015. Radical resection was achieved in 40 patients who were included in this study. Demographic and clinical data, including tumour recurrence, progression to RNU, tumour grade and overall survival (OS) were retrospectively acquired. An outcome analysis was conducted.
Median age at diagnosis was 68 years (range 42-94 years). Low grade tumours were found in 37 patients (92.5%) and high grade tumours in three patients (7.5%). Median follow-up was 53 months during which 20 patients developed upper tract recurrences (50.0%). The longest time to recurrence was 97 months. At follow-up 11 patients (27.5%) underwent an RNU and two patients died from UTUC. RNU could be avoided in 29 patients (72.5%). In this study we found that multifocality is a significant risk factor for recurrence, but not for stage progression to RNU.
PCTR is a surgically and oncologically safe procedure. Renal preservation in patients with UTUC who are eligible for percutaneous resection can be achieved in the majority of patients. Selection criteria for PCTR should be further refined, leading to a wider application of PCTR in the future. Follow-up needs invasive procedures and should be long term.
在上尿路尿路上皮癌（UTUC）的治疗中，诸如输尿管肾镜检查（URS）或经皮肿瘤切除术（PCTR）等内镜下保留肾单位的手术所起的作用仍然非常有限。这可能导致可能不必要的根治性肾输尿管切除术（RNU），而RNU仍是金标准治疗方法。日后发生慢性肾脏病（CKD）的风险很重要。在本研究中，我们展示了在单一机构中进行PCTR的24年经验结果。
我们确定了1992年至2015年间接受PCTR的44例患者。本研究纳入了40例实现根治性切除的患者。回顾性获取了人口统计学和临床数据，包括肿瘤复发、进展为RNU、肿瘤分级和总生存期（OS）。进行了结果分析。
诊断时的中位年龄为68岁（范围42 - 94岁）。37例患者（92.5%）发现为低级别肿瘤，3例患者（7.5%）为高级别肿瘤。中位随访时间为53个月，在此期间20例患者出现上尿路复发（50.0%）。最长复发时间为97个月。随访时，11例患者（27.5%）接受了RNU，2例患者死于UTUC。29例患者（72.5%）可避免行RNU。在本研究中，我们发现多灶性是复发的重要危险因素，但不是进展为RNU分期的危险因素。
PCTR是一种手术和肿瘤学上安全的手术。大多数符合经皮切除条件的UTUC患者能够实现肾脏保留。PCTR的选择标准应进一步完善，以便将来更广泛地应用PCTR。随访需要侵入性操作且应长期进行。
