肾输尿管切除术对转移性上尿路尿路上皮癌的生存影响。
Survival Effect of Nephroureterectomy in Metastatic Upper Urinary Tract Urothelial Carcinoma.
机构信息
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du Cancer de Montréal, Montréal, Québec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du Cancer de Montréal, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Clin Genitourin Cancer. 2019 Jun;17(3):e602-e611. doi: 10.1016/j.clgc.2019.03.003. Epub 2019 Mar 29.
BACKGROUND
Few data examined the potential survival benefit of nephroureterectomy (NU) in the setting of metastatic upper urinary tract urothelial carcinoma (mUTUC). We hypothesized that a survival benefit might be associated with the use of NU in that setting and tested this hypothesis within a large population-based cohort.
PATIENTS AND METHODS
Within the Surveillance, Epidemiology, and End Results database (2004-2014), we identified 1174 patients with mUTUC. Kaplan-Meier plots, as well as multivariable Cox regression models (MCRMs), relying on inverse probability after treatment weighting and landmark analyses, were used to test the effect of NU versus no surgical treatment on cancer-specific mortality (CSM) in patients with mUTUC.
RESULTS
Of 1174 patients with mUTUC, 449 (38%) underwent NU. The rate of NU decreased over time from 47.1% to 34.6% (estimated annual percentage change, -4%; P = .006]. In MCRMs, NU achieved independent predictor status for lower CSM (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.46-0.66; P < .001). In MCRMs stratified according to chemotherapy, NU also achieved independent predictor status for lower CSM, both in patients who received (n = 597; 50.9%) (HR, 0.68; 95% CI, 0.53-0.87; P = .002) or did not receive (n = 574; 49%) (HR, 0.44; 95% CI, 0.33-0.58; P < .001) chemotherapy. Virtually the same results were recorded after inverse probability after treatment weighting adjustment, as well as in landmark analyses.
CONCLUSIONS
Our analyses suggest a potential survival benefit after NU in the setting of mUTUC, regardless of chemotherapy administration.
背景
很少有数据研究肾输尿管切除术（NU）在转移性上尿路上皮癌（mUTUC）治疗中的潜在生存获益。我们假设，在这种情况下，NU 的使用可能与生存获益相关，并在一个大型基于人群的队列中检验了这一假设。
患者和方法
我们在监测、流行病学和最终结果数据库（2004-2014 年）中，确定了 1174 例 mUTUC 患者。Kaplan-Meier 图以及多变量 Cox 回归模型（MCRM），包括基于治疗后逆概率加权和标志分析，用于检验 NU 与无手术治疗对 mUTUC 患者癌症特异性死亡率（CSM）的影响。
结果
在 1174 例 mUTUC 患者中，有 449 例（38%）接受了 NU。NU 的实施率随时间从 47.1%降至 34.6%（估计每年百分比变化，-4%；P=0.006）。在 MCRM 中，NU 成为 CSM 降低的独立预测因素（风险比 [HR]，0.55；95%置信区间 [CI]，0.46-0.66；P<0.001）。在根据化疗分层的 MCRM 中，NU 也是 CSM 降低的独立预测因素，包括接受（n=597；50.9%）（HR，0.68；95%CI，0.53-0.87；P=0.002）或未接受（n=574；49%）（HR，0.44；95%CI，0.33-0.58；P<0.001）化疗的患者。经过治疗后逆概率加权调整以及标志分析后，也得到了几乎相同的结果。
结论
我们的分析表明，在 mUTUC 治疗中，NU 可能带来生存获益，无论是否进行化疗。
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