Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Republic of Korea.
Health Insurance Research Institute, National Health Insurance Service, Wonju, Republic of Korea.
PLoS One. 2021 Oct 11;16(10):e0255965. doi: 10.1371/journal.pone.0255965. eCollection 2021.
Upper urinary tract urothelial carcinomas are relatively rare and have a cancer-specific survival rate of 20%-30%. The current gold standard treatment for nonmetastatic high-grade urinary tract urothelial carcinoma is radical nephroureterectomy with bladder cuff resection.
This study aimed to compare conditional cancer-specific survival between open radical nephroureterectomy and laparoscopic radical nephroureterectomy in patients with nonmetastatic stage pT3-4 or TxN(+) locally advanced urinary tract urothelial carcinoma from five tertiary centers.
The medical records of 723 patients were retrospectively reviewed. The patients had locally advanced and nodal staged tumors and had undergone open radical nephroureterectomy (n = 388) or laparoscopic radical nephroureterectomy (n = 260) at five tertiary Korean institutions from January 2000 and December 2012. To control for heterogenic baseline differences between the two modalities, propensity score matching and subgroup analysis were conducted. Conditional survival analysis was also conducted to determine survival outcome and to overcome differences in follow-up duration between the groups.
During the median 50.8-month follow up, 255 deaths occurred. In univariate analysis, significant factors affecting cancer-specific survival (e.g., age, history of bladder cancer, American Society of Anesthesiologists score, pathological N stage, and presence of lymphovascular invasion and carcinoma in situ) differed in each subsequent year. The cancer-specific survival between patients treated with open radical nephroureterectomy and laparoscopic radical nephroureterectomy was not different between patients with and without a history of bladder cancer. After adjusting baseline differences between the two groups by using propensity score matching, both groups still had no significant differences in cancer-specific survival.
The two surgical modalities showed no significant differences in the 5-year cancer-specific survival in patients with locally advanced urinary tract urothelial carcinoma.
上尿路尿路上皮癌相对少见，其癌症特异性生存率为 20%-30%。目前，非转移性高级别尿路上皮癌的标准治疗方法是根治性肾输尿管切除术加膀胱袖状切除术。
本研究旨在比较 5 家三级中心的 723 例非转移性局部晚期 pT3-4 或 TxN(+)尿路上皮癌患者中，开放性根治性肾输尿管切除术与腹腔镜根治性肾输尿管切除术的条件性癌症特异性生存率。
回顾性分析了 723 例患者的病历资料。这些患者均患有局部晚期和淋巴结分期肿瘤，并于 2000 年 1 月至 2012 年 12 月在韩国的 5 家三级医疗机构接受了开放性根治性肾输尿管切除术（n=388）或腹腔镜根治性肾输尿管切除术（n=260）。为了控制两种方法之间异质基线差异，进行了倾向评分匹配和亚组分析。同时进行条件生存分析以确定生存结果，并克服两组之间随访时间的差异。
在中位随访 50.8 个月期间，共有 255 例患者死亡。在单因素分析中，影响癌症特异性生存的显著因素（如年龄、膀胱癌史、美国麻醉医师协会评分、病理 N 分期、淋巴血管侵犯和原位癌）在每个后续年份中均有所不同。在有或没有膀胱癌史的患者中，接受开放性根治性肾输尿管切除术和腹腔镜根治性肾输尿管切除术的患者的癌症特异性生存率之间没有差异。通过使用倾向评分匹配调整两组之间的基线差异后，两组在癌症特异性生存率方面仍无显著差异。
在局部晚期尿路上皮癌患者中，两种手术方式在 5 年癌症特异性生存率方面无显著差异。
