Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Cancer Res Treat. 2019 Jan;51(1):240-251. doi: 10.4143/crt.2017.417. Epub 2018 Apr 24.
We compared oncologic outcomes of patients with upper tract urothelial carcinoma (UTUC) who underwent open nephroureterectomy (ONU) or laparoscopic nephroureterectomy (LNU).
Consecutive cases of ONU and LNU between 2000 and 2012 at five participating institutions were included in this retrospective analysis. Clinical characteristics and pathologic outcomes were compared between the two surgical approaches. The influence of the type of surgical approach on intravesical recurrence-free survival (IVRFS), progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) was analyzed using the Kaplan-Meier method and differences were assessed with the log-rank test. Predictors of IVRFS, PFS, CSS, and OS were also analyzed with a multivariable Cox regression model.
A total of 1,521 patients with UTUC were eligible for the present study (ONU, 906; LNU, 615). The estimated 5-year IVRFS (57.8 vs. 51.0%, p=0.010), CSS (80.4 vs. 76.4%, p=0.032), and OS (75.8 vs. 71.4%, p=0.026) rates were significantly different between the two groups in favor of LNU. Moreover, in patients with locally advanced disease (pT3/pT4), the LNU group showed better 5-year IVRFS (62.9 vs. 54.1%, p=0.038), CSS (64.3 vs. 56.9%, p=0.022), and OS (60.4 vs. 53.1%, p=0.018) rates than the ONU group. Multivariable Cox regression analyses showed that type of surgical approach was independently associated with IVRFS, but was not related to PFS, CSS, and OS.
Our findings indicate that LNU provided better oncologic control of IVRFS, CSS, and OS compared with ONU for the management of patients with UTUC.
我们比较了接受开放式肾盂输尿管切除术（ONU）或腹腔镜肾盂输尿管切除术（LNU）的上尿路尿路上皮癌（UTUC）患者的肿瘤学结果。
本回顾性分析纳入了 2000 年至 2012 年在五家参与机构接受 ONU 和 LNU 的连续病例。比较了两种手术方法的临床特征和病理结果。采用 Kaplan-Meier 方法分析手术方式对膀胱内无复发生存率（IVRFS）、无进展生存率（PFS）、癌症特异性生存率（CSS）和总生存率（OS）的影响，采用对数秩检验评估差异。采用多变量 Cox 回归模型分析 IVRFS、PFS、CSS 和 OS 的预测因素。
共有 1521 例 UTUC 患者符合本研究条件（ONU，906 例；LNU，615 例）。两组 5 年 IVRFS（57.8%比 51.0%，p=0.010）、CSS（80.4%比 76.4%，p=0.032）和 OS（75.8%比 71.4%，p=0.026）率差异有统计学意义，LNU 组更优。此外，在局部进展性疾病（pT3/pT4）患者中，LNU 组 5 年 IVRFS（62.9%比 54.1%，p=0.038）、CSS（64.3%比 56.9%，p=0.022）和 OS（60.4%比 53.1%，p=0.018）率均优于 ONU 组。多变量 Cox 回归分析表明，手术方式与 IVRFS 独立相关，但与 PFS、CSS 和 OS 无关。
我们的研究结果表明，与 ONU 相比，LNU 可更好地控制 IVRFS、CSS 和 OS，从而为 UTUC 患者的治疗提供了更好的选择。
