上尿路尿路上皮癌诊断方式对根治性肾输尿管切除术术后膀胱内复发的影响：单中心系列研究和更新的荟萃分析。

The Impact of Upper Tract Urothelial Carcinoma Diagnostic Modality on Intravesical Recurrence after Radical Nephroureterectomy: A Single Institution Series and Updated Meta-Analysis.

机构信息

Department of Urology, Mayo Clinic, Rochester, Minnesota.

Department of Urology, University of California, Los Angeles, California.

出版信息

J Urol. 2021 Sep;206(3):558-567. doi: 10.1097/JU.0000000000001834. Epub 2021 Apr 28.

DOI:10.1097/JU.0000000000001834

PMID:33908802

Abstract

PURPOSE

Diagnostic ureteroscopic biopsy for upper tract urothelial carcinoma (UTUC) has been hypothesized to increase intravesical recurrence of urothelial carcinoma after radical nephroureterectomy (RNU). Moreover, the impact of ureteroscopy without biopsy or percutaneous biopsy on intravesical recurrence remains unknown. Herein, we compared post-RNU intravesical recurrences across UTUC diagnostic modalities.

MATERIALS AND METHODS

Patients undergoing RNU at our institution between 1995 and 2019 were categorized by UTUC diagnostic modality: 1) no ureteroscopy or percutaneous biopsy; 2) percutaneous biopsy; 3) ureteroscopy without biopsy; 4) ureteroscopic biopsy. Intravesical recurrences were compared using Kaplan-Meier analyses and Cox-proportional hazard models. Results of group 4 vs 1 were pooled with the literature using a fixed effects meta-analysis.

RESULTS

In a cohort of 834 RNU patients, 210 (25.2%) had undergone no ureteroscopy, 57 (6.6%) percutaneous biopsy, 125 (15.0%) ureteroscopy without biopsy, and 442 (53.0%) ureteroscopic biopsy. Two-year intravesical recurrence rates were 15.0%, 12.7%, 18.4%, and 21.9% for groups 1 through 4, respectively (p=0.09). Multivariable analysis found that group 4 had increased intravesical recurrences (HR 1.40, p=0.04) relative to group 1 while group 2 (HR 1.07, p=0.87) and group 3 (HR 1.15, p=0.54) did not. Group 4 remained associated with intravesical recurrence on subset analyses accounting for post-RNU surveillance cystoscopy frequency. On meta-analysis including 11 other series, ureteroscopic biopsy was associated with intravesical recurrence (HR 1.47, p <0.01).

CONCLUSIONS

Ureteroscopic biopsy before RNU, but not percutaneous biopsy or ureteroscopy without biopsy, was associated with increased intravesical recurrence. Clinical trials of intravesical chemotherapy after ureteroscopic biopsy are warranted to reduce intravesical recurrences.

摘要

目的

诊断性输尿管镜活检被认为会增加根治性肾输尿管切除术（RNU）后上尿路上皮癌（UTUC）的膀胱内复发率。此外，输尿管镜检查而不进行活检或经皮活检对上尿路上皮癌复发的影响仍不清楚。在此，我们比较了 UTUC 不同诊断方式下 RNU 后的膀胱内复发情况。

材料和方法

回顾性分析 1995 年至 2019 年在我院接受 RNU 的患者，根据 UTUC 的诊断方式分为 4 组：1）未行输尿管镜或经皮活检；2）经皮活检；3）行输尿管镜检查但未行活检；4）行输尿管镜活检。采用 Kaplan-Meier 分析和 Cox 比例风险模型比较膀胱内复发情况。将第 4 组与第 1 组的结果与文献进行合并，采用固定效应荟萃分析。

结果

在 834 例 RNU 患者中，210 例（25.2%）未行输尿管镜检查，57 例（6.6%）行经皮活检，125 例（15.0%）行输尿管镜检查但未行活检，442 例（53.0%）行输尿管镜活检。1、2、3、4 组的 2 年膀胱内复发率分别为 15.0%、12.7%、18.4%和 21.9%（p=0.09）。多变量分析发现，与第 1 组相比，第 4 组的膀胱内复发风险更高（HR 1.40，p=0.04），而第 2 组（HR 1.07，p=0.87）和第 3 组（HR 1.15，p=0.54）则没有。在考虑 RNU 后膀胱镜检查频率的亚组分析中，第 4 组仍与膀胱内复发相关。在包括其他 11 个系列的荟萃分析中，输尿管镜活检与膀胱内复发相关（HR 1.47，p<0.01）。