Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Department of Urology, Nippon Medical School Musashikosugi Hospital, 1-396, Kosugityo, Nakahara-ku, Kawasaki city, Kanagawa, 211-8533, Japan.
BMC Urol. 2021 Dec 2;21(1):167. doi: 10.1186/s12894-021-00932-2.
One of the major concerns of patients with upper tract urothelial carcinoma (UTUC) treated with nephroureterectomy is intravesical recurrence (IVR). The purpose of the present study was to investigate the predictive risk factors for IVR after retroperitoneoscopic nephroureterectomy (RNU) for UTUC.
Clinicopathological and surgical information were collected from the medical records of 73 patients treated with RNU for non-metastatic UTUC, without a history of or concomitant bladder cancer. The association between IVR after RNU and clinicopathological and surgery-related factors, including preoperative urine cytology and pneumoretroperitoneum time, was analyzed using the Fisher exact test.
During the median follow-up time of 39.1 months, 18 (24.7%) patients had subsequent IVR after RNU. The 1- and 3-year IVR-free survival rates were 85.9% and 76.5%, respectively. The Fisher exact test revealed that prolonged pneumoretroperitoneum time of ≥ 210 min was a risk factor for IVR in 1 year after RNU (p = 0.0358) and positive urine cytology was a risk factor for IVR in 3 years after RNU (p = 0.0352).
In UTUC, the occurrences of IVR in 1 and 3 years after RNU are highly probable when the pneumoretroperitoneum time is prolonged (≥ 210 min) and in patients with positive urine cytology, respectively. Strict follow-up after RNU is more probable recommended for these patients.
接受肾输尿管切除术治疗的上尿路上皮癌（UTUC）患者主要关注的问题之一是膀胱内复发（IVR）。本研究的目的是探讨经后腹腔镜肾输尿管切除术（RNU）治疗非转移性 UTUC 后 IVR 的预测风险因素。
从接受 RNU 治疗无转移性 UTUC 且无膀胱癌病史或同时性膀胱癌的 73 例患者的病历中收集临床病理和手术信息。使用 Fisher 精确检验分析 RNU 后 IVR 与临床病理和手术相关因素（包括术前尿液细胞学检查和腹膜后充气时间）之间的关系。
在中位随访时间 39.1 个月期间，18 例（24.7%）患者在 RNU 后发生了随后的 IVR。1 年和 3 年的 IVR 无复发生存率分别为 85.9%和 76.5%。Fisher 精确检验显示，腹膜后充气时间延长（≥210min）是 RNU 后 1 年 IVR 的危险因素（p=0.0358），而尿液细胞学检查阳性是 RNU 后 3 年 IVR 的危险因素（p=0.0352）。
在 UTUC 中，当腹膜后充气时间延长（≥210min）和尿液细胞学检查阳性时，RNU 后 1 年和 3 年发生 IVR 的可能性分别较高。建议对这些患者进行更严格的 RNU 后随访。
