Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Sci Rep. 2021 Apr 9;11(1):7828. doi: 10.1038/s41598-021-87573-5.
This study aims to compare oncologic and functional outcomes after radical nephroureterectomy (RNU) and segmental ureterectomy (SU) in patients with upper urinary tract urothelial carcinoma (UTUC). We retrospectively collected data on patients who underwent either RNU or SU of UTUC. Propensity score matching was performed among 394 cases to yield a final cohort of 40 RNU and 40 SU cases. Kaplan-Meier analysis and the log-rank test were used to compare overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), and intravesical recurrence-free survival (IVRFS) between the groups. We also compared the change in postoperative estimated glomerular filtration rate (eGFR). There was no significant difference in terms of CSS, PFS, and IVRFS between the RNU and SU groups, but the RNU group had a better OS than the SU group (p = 0.032). Postoperative eGFR was better preserved in the SU group than in the RNU group (p < 0.001). SU provides comparable CSS, PFS, and IVRFS for patients with UTUC compared to RNU, even in patients with advanced-stage and/or high-grade cancer. Further, SU achieves better preservation of renal function.
本研究旨在比较根治性肾输尿管切除术（RNU）和节段性输尿管切除术（SU）治疗上尿路上皮癌（UTUC）患者的肿瘤学和功能结局。我们回顾性收集了接受 RNU 或 SU 治疗 UTUC 的患者数据。对 394 例患者进行倾向评分匹配，得出最终的 RNU 组 40 例和 SU 组 40 例。采用 Kaplan-Meier 分析和对数秩检验比较两组患者的总生存（OS）、癌症特异性生存（CSS）、无进展生存（PFS）和膀胱内无复发生存（IVRFS）。我们还比较了术后估计肾小球滤过率（eGFR）的变化。RNU 组和 SU 组在 CSS、PFS 和 IVRFS 方面无显著差异，但 RNU 组的 OS 优于 SU 组（p=0.032）。SU 组术后 eGFR 优于 RNU 组（p<0.001）。与 RNU 相比，SU 可为 UTUC 患者提供相当的 CSS、PFS 和 IVRFS，即使是在晚期和/或高级别癌症患者中也是如此。此外，SU 还能更好地保留肾功能。
