在上尿路尿路上皮癌根治性肾输尿管切除术中，输尿管结扎时机对预后的意义。

Significance of the timing of ureteral ligation on prognosis during radical nephroureterectomy for upper urinary tract urothelial cancer.

机构信息

Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Department of Urology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan.

出版信息

Int J Urol. 2021 Feb;28(2):208-214. doi: 10.1111/iju.14435. Epub 2020 Nov 29.

DOI:10.1111/iju.14435

PMID:33283389

Abstract

OBJECTIVES

To investigate the impact on intravesical recurrence and prognosis according to the ureteral ligation timing during radical nephroureterectomy for upper urinary tract urothelial carcinoma.

METHODS

We carried out a retrospective chart review of 664 patients with non-metastatic upper urinary tract urothelial carcinoma who underwent radical nephroureterectomy with ureteral ligation (supplementary analysis of JCOG1110A). We excluded patients with previous and/or synchronous bladder cancer, clinically node-positive disease, no ureteral ligation data, those without ureteral ligation and those with any missing data. We investigated the cumulative incidence of intravesical recurrence and cancer-specific mortality, and overall survival between patients with ureteral ligation before renovascular ligation (early ureteral ligation), or ureteral ligation after renovascular ligation (late ureteral ligation).

RESULTS

Early and late ureteral ligation was carried out in 243 patients (36.6%) and 421 patients (63.4%), respectively. Intravesical recurrence occurred in 218 patients (32.8%) during follow up (median 3.9 years). No significant difference in the intravesical recurrence was found between early and late ureteral ligation groups. Meanwhile, survival in the early ureteral ligation group was significantly worse compared with the late ureteral ligation group. Multivariable analysis showed that early ureteral ligation was an independent prognostic factor for overall survival (hazard ratio 1.88, 95% confidence interval 1.24-2.85, P = 0.003) and cancer-specific mortality (hazard ratio 1.93, 95% confidence interval 1.14-3.25, P = 0.014).

CONCLUSIONS

Our findings suggest that the incidence of intravesical recurrence is not affected by the timing of ureteral ligation during radical nephroureterectomy. However, early ureteral ligation might have a negative impact on survival outcomes.

摘要

目的

研究在上尿路尿路上皮癌根治性肾输尿管切除术中不同输尿管结扎时机对膀胱内复发和预后的影响。

方法

我们对 664 例非转移性上尿路尿路上皮癌患者进行了回顾性图表分析，这些患者接受了根治性肾输尿管切除术和输尿管结扎术（JCOG1110A 的补充分析）。我们排除了既往和/或同期膀胱癌、临床淋巴结阳性疾病、无输尿管结扎数据、未行输尿管结扎和任何数据缺失的患者。我们研究了输尿管结扎于肾血管结扎前（早期输尿管结扎）或肾血管结扎后（晚期输尿管结扎）的患者之间膀胱内复发和癌症特异性死亡率以及总生存率的累积发生率。

结果

243 例（36.6%）患者行早期输尿管结扎，421 例（63.4%）患者行晚期输尿管结扎。在随访期间（中位时间 3.9 年），218 例（32.8%）患者发生膀胱内复发。早期和晚期输尿管结扎组之间膀胱内复发无显著差异。同时，早期输尿管结扎组的总生存率明显差于晚期输尿管结扎组。多变量分析显示，早期输尿管结扎是总生存率（风险比 1.88，95%置信区间 1.24-2.85，P=0.003）和癌症特异性死亡率（风险比 1.93，95%置信区间 1.14-3.25，P=0.014）的独立预后因素。