Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
J Endourol. 2021 Mar;35(3):312-318. doi: 10.1089/end.2020.0496. Epub 2020 Nov 16.
Robotic radical nephroureterectomy (RRNU) may offer advantages over laparoscopic radical nephroureterectomy (LRNU). The purpose of this study is to evaluate the overall survival (OS) of patients with upper tract urothelial carcinoma (UTUC) who underwent RRNU LRNU and identify factors that account for differences. The National Cancer Database was queried from 2010 to 2016 for patients with American Joint Committee on Cancer 6th/7th edition Stage I/II/III UTUC. Kaplan-Meier analysis compared LRNU and RRNU OS. Univariate analysis detected differences between the groups. Cox regression determined factors associated with mortality rate. Logistic regression identified predictors of a lymph node dissection (LND) and 90-day mortality rate. A total of 2631 patients met the criteria, 1129 of whom underwent RRNU and 1502 LRNU, with a follow-up of 33 and 35 months, respectively ( = 0.063). RRNU had a median OS of 71.1 62.6 months ( = 0.033). LRNU patients were older (72.7 71.4, < 0.001) and had no differences in comorbidities, pathologic T stage, or grade. The LRNU cohort was less likely to undergo LND (19% 35%, < 0.001) and had a lower median lymph node yield (3 4, < 0.001). LRNU patients more likely underwent conversion to an open procedure, had longer hospital stays, and higher 30- and 90-day mortality rates. LRNU was independently associated with mortality rate ( = 0.030). Age, grade, positive margins, pT/pN stage were associated with mortality rate. Younger age, RRNU, surgery at an academic center, and neoadjuvant chemotherapy predicted an LND. RRNU demonstrated increased rates of LND and may offer a short-term morbidity benefit to LRNU. Survival differences may be due to improved characterization of disease through LND.
机器人根治性肾输尿管切除术（RRNU）可能优于腹腔镜根治性肾输尿管切除术（LRNU）。本研究旨在评估接受 RRNU 和 LRNU 的上尿路尿路上皮癌（UTUC）患者的总生存率（OS），并确定导致差异的因素。从 2010 年到 2016 年，国家癌症数据库（National Cancer Database）对美国癌症联合委员会第 6 版/第 7 版 I/II/III 期 UTUC 患者进行了查询。Kaplan-Meier 分析比较了 LRNU 和 RRNU 的 OS。单因素分析检测到两组之间的差异。Cox 回归确定了死亡率相关因素。Logistic 回归确定了淋巴结清扫（LND）和 90 天死亡率的预测因子。共有 2631 名患者符合标准，其中 1129 名接受 RRNU，1502 名接受 LRNU，随访时间分别为 33 个月和 35 个月（ = 0.063）。RRNU 的中位 OS 为 71.1 个月和 62.6 个月（ = 0.033）。LRNU 患者年龄更大（72.7 岁和 71.4 岁， < 0.001），且合并症、病理 T 分期和分级无差异。LRNU 组 LND 发生率较低（19%和 35%， < 0.001），淋巴结中位数较少（3 个和 4 个， < 0.001）。LRNU 患者更可能转为开放手术，住院时间更长，30 天和 90 天死亡率更高。LRNU 与死亡率独立相关（ = 0.030）。年龄、分级、阳性切缘、pT/pN 分期与死亡率相关。年龄较小、RRNU、在学术中心手术和新辅助化疗预测行 LND。RRNU 显示 LND 发生率增加，与 LRNU 相比可能具有短期发病率获益。生存差异可能是由于 LND 对疾病进行了更好的描述。
