Al Hussein Al Awamlh Bashir, Shoag Jonathan E, Basourakos Spyridon P, Lewicki Patrick J, Posada Lina, Ma Xiaoyue, Raman Jay D, Shariat Shahrokh F, Scherr Douglas
Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY.
Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY; Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Urology. 2021 Aug;154:127-135. doi: 10.1016/j.urology.2021.03.003. Epub 2021 Mar 22.
To determine factors associated with performing inadvertent radical nephrectomy (RN) for upper tract urothelial carcinoma (UTUC), and to assess the impact of radical nephrectomy on overall survival (OS) compared to radical nephroureterectomy (NU).
Using the National Cancer Database (NCDB), patients with UTUC of the renal pelvis who were diagnosed with renal cortical tumors and underwent RN (n = 820) with subsequent surgical pathology demonstrating urothelial carcinoma were identified. These patients were compared to those diagnosed with renal pelvis tumors who appropriately underwent NU (n = 16,464) between 2005 and 2015. Multivariable logistic regression was used to determine patient, facility and tumor-related factors associated with undergoing RN. The impact of surgery (RN vs NU) on OS was determined by Cox-regression after propensity score matching.
A total of 4.7% patients with UTUC underwent inadvertent RN. Black race (adjusted odds ratio [aOR] 1.62, 95%CI 1.23-2.13), larger tumors, advanced tumor stage, and high-grade tumors (P < 0.0001) were associated with RN. However, surgery at a facility performing a higher volume of NU/year was associated with lower odds of having RN performed (aOR 0.85, 95%CI 0.75-0.97). After propensity score matching, the 5-year OS was 39.9% for those undergoing RN vs 49.9% for those undergoing NU (hazard ratio 1.45, 95%CI 1.30-1.62).
Inadvertent RN is not uncommon, occurring in almost 5% of patients with UTUC in the NCDB. Patients who underwent RN had significantly worse OS as compared to those treated with NU. These data highlight that accurate diagnosis of UTUC is paramount and clinicians should not hesitate to perform further workup when imaging findings are equivocal.
确定与上尿路尿路上皮癌（UTUC）行意外根治性肾切除术（RN）相关的因素，并评估根治性肾切除术与根治性肾输尿管切除术（NU）相比对总生存期（OS）的影响。
利用国家癌症数据库（NCDB），识别出肾盂UTUC患者，这些患者被诊断为肾皮质肿瘤并接受了RN（n = 820），随后手术病理证实为尿路上皮癌。将这些患者与2005年至2015年间被诊断为肾盂肿瘤并适当接受NU（n = 16,464）的患者进行比较。采用多变量逻辑回归确定与接受RN相关的患者、机构和肿瘤相关因素。在倾向得分匹配后，通过Cox回归确定手术（RN与NU）对OS的影响。
共有4.7%的UTUC患者接受了意外RN。黑人种族（调整优势比[aOR] 1.62，95%CI 1.23 - 2.13）、肿瘤较大、肿瘤分期较晚和高级别肿瘤（P < 0.0001）与RN相关。然而，在每年进行更多例NU手术的机构进行手术与进行RN的较低几率相关（aOR 0.85，95%CI 0.75 - 0.97）。倾向得分匹配后，接受RN的患者5年OS为39.9%，而接受NU的患者为49.9%（风险比1.45，95%CI 1.30 - 1.62）。
意外RN并不罕见，在NCDB中几乎5%的UTUC患者中发生。与接受NU治疗的患者相比，接受RN的患者OS明显更差。这些数据突出表明，UTUC的准确诊断至关重要，当影像学检查结果不明确时，临床医生应毫不犹豫地进行进一步检查。
