节段性输尿管切除术可安全地应用于远端输尿管尿路上皮癌患者。
Segmental ureterectomy can be performed safely in patients with urothelial carcinoma of distal ureter.
作者信息
Jia Zhuo, Gong Yan-Qing, Zhang Cui-Jian, Bao Zheng-Qing, Li Xue-Song, Hao Han, Xiong Geng-Yan, Zhang Lei, Fang Dong, He Zhi-Song, Zhou Li-Qun
机构信息
Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China.
出版信息
Can Urol Assoc J. 2019 Jul;13(7):E202-E209. doi: 10.5489/cuaj.5555.
INTRODUCTION
We aimed to compare oncological outcomes by surgery type (segmental ureterectomy [SU] vs. radical nephroureterectomy [RNU]) in a large cohort of patients with upper tract urothelial carcinoma (UTUC) of the distal ureter.
METHODS
We performed a retrospective analysis of 219 patients with UTUC of the distal ureter among 931 patients with UTUC who underwent SU and RNU. Clinicopathological outcomes were evaluated. Cancer-specific survival (CSS), overall survival (OS), local recurrence-free survival (RFS), intravesical recurrence-free survival (IVRFS), contralateral recurrence-free survival, and distal metastasis-free survival were assessed by the Kaplan-Meier method and Cox regression, estimating hazard ratios (HR) and 95% confidence intervals (CIs).
RESULTS
A total of 179 (81.7%) patients underwent RNU and 40 (18.3%) underwent SU: 85 males (47.5%) with RNU and 17 (42.5%) with SU (p=0.568). The median age with RNU and SU was 71 years (range 31-86) and 70 years (range 46-90), respectively (p=0.499). The T stage of the two groups did not differ (p=0.122), nor did mean tumour length (3.35±2.62 vs. 3.25±2.14; p=0.953), grade (p=0.075), tumour necrosis (p=0.634), or followup time (months) (58.1±8.1 vs. 63.7±3.4; p=0.462). The two groups did not differ in CSS (p=0.358) or OS (p=0.206), and surgery type did not predict CSS (HR 0.862; 95% CI 0.469-1.585; p=0.633) or OS (HR 0.764; 95% CI 0.419-1.392; p=0.379). Local RFS was higher with RNU than SU (96.2% vs. 86.0%; p=0.02), but the groups did not differ in IVRFS (p=0.661), contralateral RFS (p=0.183), or distant metastasis-free survival (p=0.078). On multivariate analysis, SU was associated with local RFS (HR 5.069; 95% CI 1.029-24.968; p=0.046) and distant metastasis-free survival (HR 6.497; 95% CI 1.196-35.283; p=0.03). Local RFS was lower with SU than RNU for patients with pT3-4 stage (p=0.006).
CONCLUSIONS
Long-term oncological outcomes were equivalent with SU and RNU in patients with UTUC of the distal ureter. SU affected local recurrence survival, especially with advanced tumour stage, and distant metastasis survival.
引言
我们旨在比较在一大群远端输尿管上尿路尿路上皮癌（UTUC）患者中，不同手术方式（节段性输尿管切除术[SU]与根治性肾输尿管切除术[RNU]）的肿瘤学结局。
方法
我们对931例行SU和RNU的UTUC患者中的219例远端输尿管UTUC患者进行了回顾性分析。评估了临床病理结局。采用Kaplan-Meier法和Cox回归评估癌症特异性生存（CSS）、总生存（OS）、局部无复发生存（RFS）、膀胱内无复发生存（IVRFS）、对侧无复发生存和远处无转移生存，估计风险比（HR）和95%置信区间（CI）。
结果
共有179例（81.7%）患者接受了RNU，40例（18.3%）接受了SU：接受RNU的男性有85例（47.5%），接受SU的男性有17例（42.5%）（p = 0.568）。接受RNU和SU患者的中位年龄分别为71岁（范围31 - 86岁）和70岁（范围46 - 90岁）（p = 0.499）。两组的T分期无差异（p = 0.122），平均肿瘤长度也无差异（3.35±2.62对3.25±2.14；p = 0.953），分级无差异（p = 0.075），肿瘤坏死无差异（p = 0.634），随访时间（月）也无差异（58.1±8.1对63.7±3.4；p = 0.462）。两组在CSS（p = 0.358）或OS（p = 0.206）方面无差异，手术方式不能预测CSS（HR 0.862；95% CI 0.469 - 1.585；p = 0.633）或OS（HR 0.764；95% CI 0.419 - 1.392；p = 0.379）。RNU的局部RFS高于SU（96.2%对86.0%；p = 0.02），但两组在IVRFS（p = 0.661）、对侧RFS（p = 0.
Zotero 插件