Huang Zixiong, Zhang Xiaowei, Zhang Xiaopeng, Li Qing, Liu Shijun, Yu Luping, Xu Tao
Department of Urology, Peking University People's Hospital, Beijing, P. R. China.
J Invest Surg. 2019 Dec;32(8):746-753. doi: 10.1080/08941939.2018.1457192. Epub 2018 Apr 25.
: To determine if segmental ureterectomy (SU) could be chosen for wider oncological indications than low-risk ureteral carcinoma, given the difficulties in accurate preoperative risk stratification determination and kidney-sparing needs for successive therapy. : Data from ureteral carcinoma patients who underwent open SU or laparoscopic radical nephroureterectomy (RNU) between 2011 and 2016 were retrospectively reviewed. Kaplan-Meier survival analysis and Cox regression model with patients' baseline characteristics (age, bladder cancer history, hydronephrosis), procedure type, and tumor characteristics (site, size, pathological features) as covariates were used to evaluate oncological outcomes. Life quality parameters including preoperative renal function, Karnofsky performance status, pain score, and surgical complications were set as second endpoints. : Sixty-three patients (24 in SU group, 39 in RNU group) who had at least one high-risk factor were enrolled. In the mean follow-up time of 24.67 months, no significant difference was found in recurrence-free survival (66.7% and 69.2%, = 0.798), overall survival (79.2% and 84.6%, = 0.453), and cancer-specific survival (83.3% and 89.7%, = 0.405) between SU and RNU groups. The Cox regression demonstrated that procedure type was not associated with oncological outcomes. Patients in SU group experienced significant mean estimated glomerular filtration rate (eGFR) increase by 4.60 ml/(min·1.73 m) ( < 0.001). Proportion of patients having poor eGFR also decreased postoperatively in SU group. Mere tendency in physical performance status improvement and serious complications reduction was detected in SU group. : SU is acceptable for high-risk ureteral carcinoma comparing to RNU with satisfying tumor control efficacy and advantage in renal function preservation.
鉴于术前准确的风险分层判定存在困难以及后续治疗对保留肾脏的需求，旨在确定节段性输尿管切除术（SU）是否可用于比低风险输尿管癌更广泛的肿瘤学适应证。回顾性分析了2011年至2016年间接受开放性SU或腹腔镜根治性肾输尿管切除术（RNU）的输尿管癌患者的数据。以患者的基线特征（年龄、膀胱癌病史、肾积水）、手术类型和肿瘤特征（部位、大小、病理特征）作为协变量，采用Kaplan-Meier生存分析和Cox回归模型来评估肿瘤学结局。将包括术前肾功能、卡诺夫斯基功能状态、疼痛评分和手术并发症在内的生活质量参数设定为次要终点。纳入了63例至少有一个高危因素的患者（SU组24例，RNU组39例）。在平均24.67个月的随访时间里，SU组和RNU组在无复发生存率（66.7%和69.2%，P = 0.798）、总生存率（79.2%和84.6%，P = 0.453）和癌症特异性生存率（83.3%和89.7%，P = 0.405）方面未发现显著差异。Cox回归表明手术类型与肿瘤学结局无关。SU组患者的平均估计肾小球滤过率（eGFR）显著增加了4.60 ml/（min·1.73 m²）（P < 0.001）。SU组术后eGFR差的患者比例也有所下降。SU组仅在身体功能状态改善和严重并发症减少方面有一定趋势。与RNU相比，SU对于高危输尿管癌是可接受的，具有令人满意的肿瘤控制效果和保留肾功能的优势。
