腹腔镜与开放性根治性肾输尿管切除术治疗 T3N0M0 上尿路尿路上皮癌患者的长期肿瘤学结果：多中心队列研究，并通过倾向评分匹配进行调整。
Long-Term Oncologic Outcomes of Laparoscopic Versus Open Radical Nephroureterectomy for Patients with T3N0M0 Upper Tract Urothelial Carcinoma: A Multicenter Cohort Study with Adjustment by Propensity Score Matching.
机构信息
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Department of Preventive Medicine and Public Health, Biostatistics Unit at the Clinical Translational Research Center, Keio University School of Medicine, Tokyo, Japan.
出版信息
Ann Surg Oncol. 2019 Oct;26(11):3774-3781. doi: 10.1245/s10434-019-07623-1. Epub 2019 Jul 16.
BACKGROUND
This study aimed to investigate the long-term oncologic outcomes of laparoscopic radical nephroureterectomy (LRNU) and open radical nephroureterectomy (ORNU) for patients with clinical and pathologic T3N0M0 upper tract urothelial carcinoma (UTUC).
METHODS
Among 375 UTUC patients who underwent radical nephroureterectomy, this study identified 144 pT3N0M0 patients as cohort 1 after propensity score (PS) matching. Among 399 UTUC patients, the study identified 110 cT3N0M0 patients as cohort 2 after PS matching. Oncologic outcomes such as intravesical recurrence-free survival (IVRFS) and cancer-specific survival (CSS) were assessed by multivariate Cox's regression analysis.
RESULTS
Cohort 1 of pT3N0M0 UTUC had 3-year CSS and IVRFS rates of 67.9 and 52.7%, respectively, in the LRNU group, which were significantly lower than in the ORNU group (81.4%, p = 0.039 and 71.6%, p = 0.046). The multivariate Cox's regression analysis identified the type of surgical approach (LRNU vs. ORNU) as one of the independent prognostic factors for CSS (hazard rate [HR], 1.88, p = 0.043) and IVRFS (HR, 1.75, p = 0.049). Cohort 2 of cT3N0M0 UTUC had 3-year CSS and IVRFS rates of 48.5 and 41.4%, respectively, in the LRNU group, which were significantly lower than in the ORNU group (65.8%, p = 0.049 and 67.2%, p = 0.047), and the type of surgical approach (LRNU vs. ORNU) remained as one of the independent prognostic factors for CSS and IVRFS.
CONCLUSIONS
Based on clinical and pathologic T3N0M0 UTUC populations after PS adjustments, LRNU resulted in poorer CSS and IVRFS than ORNU.
背景
本研究旨在探讨腹腔镜根治性肾输尿管切除术（LRNU）和开放性根治性肾输尿管切除术（ORNU）治疗临床病理 T3N0M0 上尿路上皮癌（UTUC）患者的长期肿瘤学结果。
方法
在 375 例接受根治性肾输尿管切除术的 UTUC 患者中，本研究通过倾向评分（PS）匹配，确定了 144 例 pT3N0M0 患者作为队列 1。在 399 例 UTUC 患者中，本研究通过 PS 匹配确定了 110 例 cT3N0M0 患者作为队列 2。通过多变量 Cox 回归分析评估了膀胱内无复发生存率（IVRFS）和癌症特异性生存率（CSS）等肿瘤学结果。
结果
队列 1 的 pT3N0M0 UTUC 患者在 LRNU 组的 3 年 CSS 和 IVRFS 率分别为 67.9%和 52.7%，显著低于 ORNU 组（81.4%，p=0.039 和 71.6%，p=0.046）。多变量 Cox 回归分析确定手术方式（LRNU 与 ORNU）为 CSS（危险比 [HR]，1.88，p=0.043）和 IVRFS（HR，1.75，p=0.049）的独立预后因素之一。队列 2 的 cT3N0M0 UTUC 患者在 LRNU 组的 3 年 CSS 和 IVRFS 率分别为 48.5%和 41.4%，显著低于 ORNU 组（65.8%，p=0.049 和 67.2%，p=0.047），手术方式（LRNU 与 ORNU）仍然是 CSS 和 IVRFS 的独立预后因素之一。
结论
基于 PS 调整后的临床病理 T3N0M0 UTUC 人群，LRNU 导致 CSS 和 IVRFS 劣于 ORNU。
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