Department of Urology, Faculty of Medicine, Çukurova University, Adana, Turkey.
Department of Urology, Faculty of Medicine, Çukurova University, Adana, Turkey,
Urol Int. 2021;105(3-4):291-297. doi: 10.1159/000511650. Epub 2020 Dec 2.
The objective of this study is to evaluate the effect of diagnostic ureterorenoscopy (URS) prior to radical nephroureterectomy (RNU) on intravesical recurrence (IVR), in patients with primary upper urinary tract urothelial carcinoma (UTUC).
Retrospective analysis of 354 patients, who underwent RNU for UTUC from 10 urology centers between 2005 and 2019, was performed. The primary endpoint was the occurrence of IVR after RNU. Patients were divided into URS prior to RNU (Group 1) and no URS prior to RNU (Group 2). Rates of IVR after RNU were compared, and a Cox proportional hazards model was used to evaluate potential predictors of IVR.
After exclusion, a total of 194 patients were analyzed: Group 1 n = 95 (49.0%) and Group 2 n = 99 (51.0%). In Group 1, a tumor biopsy and histopathological confirmation during URS were performed in 58 (61.1%). The mean follow-up was 39.17 ± 39.3 (range 12-250) months. In 54 (27.8%) patients, IVR was recorded after RNU, and the median recurrence time within the bladder was 10.0 (3-144) months. IVR rate was 38.9% in Group 1 versus 17.2% in Group 2 (p = 0.001). In Group 1, IVR rate was 43.1% in those undergoing intraoperative biopsy versus 32.4% of patients without biopsy during diagnostic URS (p =0.29). Intravesical recurrence-free survival (IRFS) was longer in Group 2 compared to Group 1 (median IRFS was 111 vs. 60 months in Groups 2 and 1, respectively (p< 0.001)). Univariate analysis revealed that IRFS was significantly associated with URS prior to RNU (HR: 2.9, 95% CI 1.65-5.41; p < 0.001). In multivariate analysis, URS prior to RNU (HR: 3.5, 95% CI 1.74-7.16; p < 0.001) was found to be an independent prognostic factor for IRFS.
Diagnostic URS was associated with the poor IRFS following RNU for primary UTUC. The decision for a diagnostic URS with or without tumor biopsy should be reserved for cases where this information might influence further treatment decisions.
本研究旨在评估原发性上尿路尿路上皮癌（UTUC）患者行根治性肾输尿管切除术（RNU）前诊断性输尿管镜检查（URS）对膀胱内复发（IVR）的影响。
对 2005 年至 2019 年间在 10 个泌尿外科中心接受 RNU 治疗的 354 例 UTUC 患者进行回顾性分析。主要终点是 RNU 后 IVR 的发生。患者分为 RNU 前行 URS 组（Group 1）和 RNU 前行 URS 组（Group 2）。比较 RNU 后 IVR 的发生率，并使用 Cox 比例风险模型评估 IVR 的潜在预测因素。
排除后，共分析了 194 例患者：Group 1 n = 95（49.0%）和 Group 2 n = 99（51.0%）。在 Group 1 中，58 例（61.1%）在 URS 期间进行了肿瘤活检和组织病理学证实。平均随访时间为 39.17 ± 39.3（范围 12-250）个月。在 54 例（27.8%）患者中，RNU 后记录到 IVR，膀胱内复发时间中位数为 10.0（3-144）个月。Group 1 的 IVR 发生率为 38.9%，Group 2 为 17.2%（p = 0.001）。在 Group 1 中，术中活检组的 IVR 发生率为 43.1%，而诊断性 URS 期间无活检组的 IVR 发生率为 32.4%（p =0.29）。与 Group 1 相比，Group 2 的膀胱内无复发生存率（IRFS）更长（Group 2 和 Group 1 的中位 IRFS 分别为 111 个月和 60 个月（p< 0.001））。单因素分析显示，IRFS 与 RNU 前 URS 显著相关（HR：2.9，95%CI 1.65-5.41；p < 0.001）。多因素分析显示，RNU 前 URS（HR：3.5，95%CI 1.74-7.16；p < 0.001）是 IRFS 的独立预后因素。
诊断性 URS 与原发性 UTUC 患者 RNU 后 IRFS 不良相关。是否进行诊断性 URS 加或不加肿瘤活检的决定应保留给可能影响进一步治疗决策的病例。
