The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Urol. 2021 Apr;205(4):1039-1046. doi: 10.1097/JU.0000000000001505. Epub 2020 Nov 20.
We reviewed the oncologic and surgical outcomes of endoscopic treatments for low grade upper tract urothelial carcinoma, and assessed the prognostic significance of tumor size, location and multifocality.
We retrospectively reviewed all patients who underwent endoscopic treatment for low grade upper tract urothelial carcinoma at our institution between 2014 and 2019. Tumors were treated with a dual laser generator, which alternately produces holmium and neodymium lasers. A stringent ureteroscopic followup protocol was conducted. We looked for an association between outcome and tumor size, location or multifocality, and for predictive factors for time to local recurrence and progression.
The cohort included 59 patients (62 renal units), 27% of tumors were multifocal and 40% were >2 cm. The median followup time was 22 months (IQR 11-41), and the median number of ureteroscopies was 5.5 (4-9). Local recurrence was observed in 46 renal units (74.1%) at a median of 6.5 months after initial surgery. Four patients (6.4%) developed disease progression and were referred for radical surgery: 2 had pathological progression and 2 had a rapid and high volume local recurrence, and 1 later developed metastatic disease. The progression-free rate was 93.2%. Tumor location in kidney (p=0.03, HR 1.95) and multifocality (p=0.005, HR 3.25) significantly predicted time to local recurrence. No factor predicted time to progression.
Ureteroscopic treatment of large, multifocal, low grade upper tract urothelial carcinoma is feasible, does not involve significant complications and has good short-term oncologic outcomes, with a 93.2% progression-free survival rate. Tumors located in the kidney and multifocality yielded shorter time to local recurrence but not progression.
我们回顾了内镜治疗低级别上尿路尿路上皮癌的肿瘤学和手术结果，并评估了肿瘤大小、位置和多灶性的预后意义。
我们回顾性分析了 2014 年至 2019 年期间在我院接受内镜治疗的低级别上尿路尿路上皮癌患者。使用双激光发生器治疗肿瘤，该发生器交替产生钬激光和钕激光。采用严格的输尿管镜随访方案。我们研究了肿瘤大小、位置或多灶性与治疗结果之间的关系，并寻找局部复发和进展的预测因素。
该队列包括 59 例患者（62 个肾脏单位），27%的肿瘤为多灶性，40%的肿瘤>2cm。中位随访时间为 22 个月（IQR 11-41），中位输尿管镜检查次数为 5.5 次（4-9 次）。初次手术后中位 6.5 个月时，46 个肾脏单位（74.1%）出现局部复发。4 例患者（6.4%）发生疾病进展并接受根治性手术：2 例患者发生病理进展，2 例患者局部复发迅速且体积大，1 例患者后来发生转移性疾病。无进展生存率为 93.2%。肿瘤位置在肾脏（p=0.03，HR 1.95）和多灶性（p=0.005，HR 3.25）显著预测局部复发时间。没有因素预测进展时间。
输尿管镜治疗大、多灶、低级别上尿路尿路上皮癌是可行的，不会导致严重并发症，且具有良好的短期肿瘤学结果，无进展生存率为 93.2%。位于肾脏的肿瘤和多灶性肿瘤会导致较短的局部复发时间，但不会导致进展。
