Huang Yun-Ching, Liu Yu-Liang, Chen Miao-Fen, Chen Chih-Shou, Wu Chun-Te
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi 613, Taiwan.
Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
Diagnostics (Basel). 2021 Oct 22;11(11):1966. doi: 10.3390/diagnostics11111966.
To investigate postoperative complications and oncologic outcomes of prophylactic nephroureterectomy and/or cystectomy in dialysis patients with urothelial carcinoma (UC), we retrospectively reviewed the records of dialysis patients with UC and a final status of complete urinary tract extirpation (CUTE, i.e., the removal of both kidneys, ureters, and bladder) between January 2004 and December 2015. Patients undergoing dialysis after initial radical nephroureterectomy and/or cystectomy were excluded. Eighty-four and 27 dialysis patients, undergoing one-stage and multi-stage CUTE, were enrolled in this study, respectively. Demographic, medical, perioperative, and pathologic features were collected to determine variables associated with oncologic outcomes. Although there was no significant difference in mortality between the 2 groups ( = 0.333), all 5 (4.5%) patients with Clavien-Dindo grade 5 complications were from the one-stage CUTE group. On multivariate logistic regression analysis, advanced age ( = 0.042) and high Charlson comorbidity index (CCI) ( = 0.000) were related to postoperative major complications. Compared with multi-stage CUTE, one-stage CUTE had no overall, cancer-specific, and recurrence-free survival benefits (all > 0.05). According to multivariate analysis with Cox regression, age > 70 years (HR 2.70, 95% CI 1.2-6.12; = 0.017), CCI ≥ 5 (HR 2.16, 95% CI 1.01-4.63; = 0.048), and bladder cancer stage ≥ 3 (HR 12.4, 95% CI 1.82-84.7; = 0.010) were independent, unfavorable prognostic factors for the overall survival. One-stage CUTE is not associated with superior oncologic outcomes, and all perioperative mortalities in our series occurred in the one-stage CUTE group. Our data do not support prophylactic nephroureterectomy and/or cystectomy for uremic patients with UC.
为了研究接受预防性肾输尿管切除术和/或膀胱切除术的透析患者发生尿路上皮癌（UC）后的术后并发症及肿瘤学结局，我们回顾性分析了2004年1月至2015年12月期间接受完全尿路切除（CUTE，即切除双侧肾脏、输尿管和膀胱）的透析患者的UC记录。排除初次根治性肾输尿管切除术和/或膀胱切除术后接受透析的患者。本研究分别纳入了84例接受一期CUTE的透析患者和27例接受多期CUTE的透析患者。收集人口统计学、医学、围手术期和病理特征以确定与肿瘤学结局相关的变量。尽管两组之间的死亡率无显著差异（P = 0.333），但所有5例（4.5%）Clavien-Dindo 5级并发症患者均来自一期CUTE组。多因素逻辑回归分析显示，高龄（P = 0.042）和高Charlson合并症指数（CCI）（P = 0.000）与术后严重并发症相关。与多期CUTE相比，一期CUTE在总生存、癌症特异性生存和无复发生存方面并无优势（所有P>0.05）。根据Cox回归多因素分析，年龄>70岁（HR 2.70，95%CI 1.2 - 6.12；P = 0.017）、CCI≥5（HR 2.16，95%CI 1.01 - 4.63；P = 0.048）以及膀胱癌分期≥3（HR 12.4，95%CI 1.82 - 84.7；P = 0.010）是总生存的独立不良预后因素。一期CUTE与更好的肿瘤学结局无关，我们系列中的所有围手术期死亡均发生在一期CUTE组。我们的数据不支持对患有UC的尿毒症患者进行预防性肾输尿管切除术和/或膀胱切除术。
