Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain.
Dipartimento di Scienze Mediche, Universitá degli Studi di Sassari, Sassari, Italy.
J Endourol. 2021 Nov;35(11):1593-1600. doi: 10.1089/end.2021.0133. Epub 2021 Jun 24.
Appropriate risk stratification and complete tumor ablation are the key factors to optimize the oncologic outcomes of patients undertaking endoscopic management for upper urinary tract urothelial carcinoma (UTUC). We aimed to identify risk factors associated to tumor recurrence and progression in a contemporary cohort of patients diagnosed and treated with the latest endourologic technologies. Forty-seven patients were selected between January-2015 and March-2019 for an endoscopic management of UTUC. Last generation of digital ureteroscopes with image-enhancing technologies were used for the detection of the lesions. The retrograde approach was the most frequent access ( = 45/47). The confocal laser endomicroscopy and multiple biopsy devices were variably used according to site and tumor presentation for their characterization. Holmium and Thulium lasers were variably used, with their combination being the preferred approach in case of larger lesions. Primary endpoints included the identification of factors associated with UTUC recurrence and progression, and bladder tumor recurrence. Median follow-up (FU) was 24 months (interquartile range 17-44). On multivariate analysis, bladder cancer (BC) recurrence was associated to previous contralateral UTUC (hazard ratios: 5.08 confidence interval [95% CI: 1.35-18.94], < 0.05) and tumor size (hazard ratios: 1.07 [95% CI: 1.00-1.14], < 0.05). UTUC recurrence was associated to incomplete clearance after primary treatment (hazard ratios: 4.99 [95% CI: 1.15-21.62], < 0.05), while UTUC progression was significantly related to the number of UTUC recurrences (hazard ratios: 3.10 [95% CI: 1.27-7.53], < 0.05). No significant survival differences in BC/UTUC recurrence, as well as in UTUC progression, were detected between risk groups. No Clavien-Dindo grade >2 were detected; one patient developed ureteric stricture at 7-month FU. Limitations involve retrospective nature of the study and relatively small number of patients. The appropriate use of latest technology may enhance the oncologic outcomes of the endoscopic management of UTUC without compromising the safety of the approach. Among the prognostic factors identified in our series, UTUC recurrence seems to be associated to disease progression.
在上尿路尿路上皮癌（UTUC）的内镜管理中，适当的风险分层和完全肿瘤消融是优化患者肿瘤学结果的关键因素。我们旨在确定与当代患者队列中肿瘤复发和进展相关的风险因素，这些患者接受了最新的腔内泌尿外科技术的诊断和治疗。
2015 年 1 月至 2019 年 3 月期间，有 47 例患者因 UTUC 接受内镜治疗。病变的检测采用了最新一代的具有图像增强技术的数字输尿管镜。逆行入路是最常见的入路（ = 45/47）。根据病变部位和表现，灵活使用共聚焦激光内镜检查和多次活检设备对其进行特征描述。钬激光和铥激光的使用方式不同，两者结合是较大病变的首选方法。主要终点包括确定与 UTUC 复发和进展以及膀胱癌复发相关的因素。中位随访时间（FU）为 24 个月（四分位距 17-44）。多变量分析显示，膀胱癌（BC）复发与对侧 UTUC（风险比：5.08 置信区间[95%CI：1.35-18.94]， < 0.05）和肿瘤大小（风险比：1.07 [95%CI：1.00-1.14]， < 0.05）有关。原发性治疗后不完全清除与 UTUC 复发有关（风险比：4.99 [95%CI：1.15-21.62]， < 0.05），而 UTUC 进展与 UTUC 复发次数显著相关（风险比：3.10 [95%CI：1.27-7.53]， < 0.05）。在 BC/UTUC 复发和 UTUC 进展的风险组之间，未检测到生存率的显著差异。未发现 Clavien-Dindo 分级>2 级；1 例患者在 FU 7 个月时出现输尿管狭窄。研究的局限性在于其回顾性和患者数量相对较少。适当使用最新技术可提高 UTUC 内镜治疗的肿瘤学结果，而不会影响该方法的安全性。在我们的系列研究中确定的预后因素中，UTUC 复发似乎与疾病进展有关。
