Hendriks Nora, Baard Joyce, Beerlage Harrie P, Schout Barbara M A, Doherty Klara S G, Pelger Rob C M, Kamphuis Guido M
Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Urology, Alrijne Hospital, Leiderdorp, The Netherlands.
Eur Urol Open Sci. 2022 May 2;40:104-111. doi: 10.1016/j.euros.2022.04.007. eCollection 2022 Jun.
Current European Association of Urology (EAU) guidelines discriminate between high- and low-risk upper urinary tract urothelial carcinoma (UTUC) to determine treatment by means of radical nephroureterectomy (RNU) or kidney-sparing surgery (KSS).
To compare long-term oncological outcomes and renal function for patients with UTUC treated by RNU versus KSS.
A retrospective cohort study, including 186 renal units with nonmetastatic UTUC treated in a tertiary referral centre between 2010 and 2021, was conducted.
RNU, ureterorenoscopy, percutaneous tumour resection, and segmental ureteral resection.
Recurrence-free survival, metastasis-free survival (MFS), overall survival (OS), cancer-specific survival (CSS), and renal function were analysed by means of the log-rank test and the independent-sample test.
OS was 71.1% for the RNU group and 81.9% for the KSS group. In a cohort matched for propensity weight based on EAU risk stratification progression-free survival (PFS; RNU 96.0%; KSS 86.0%), MFS (RNU 72.0%; KSS 84.0%), CSS (RNU 84.0%; KSS 86.0%), and OS (RNU 76.0%; KSS 76.0%) were all similar between both groups. No significant differences in renal function were seen at 2 and 5 yr after the intervention. Although this series represents the largest cohort of (high-risk) UTUC patients treated by means of KSS to date, it is not suitable for performing a multivariate analysis.
PFS, MFS, CSS, and OS were all comparable when analysing the RNU and KSS groups. Similar results for groups with evenly distributed risk factors and a large percentage of high-risk disease suggest that current risk stratification might not be accurate in discriminating low-risk from high-risk disease.
In this report, we looked at outcomes for upper urinary tract urothelial carcinoma in a specialised hospital. We conclude that kidney-sparing surgery and radical nephroureterectomy have comparable outcomes and that risk factors for worse outcome might not be identified correctly.
当前欧洲泌尿外科学会（EAU）指南区分高风险和低风险上尿路尿路上皮癌（UTUC），以通过根治性肾输尿管切除术（RNU）或保留肾单位手术（KSS）来确定治疗方案。
比较接受RNU与KSS治疗的UTUC患者的长期肿瘤学结局和肾功能。
设计、设置与参与者：开展了一项回顾性队列研究，纳入2010年至2021年间在一家三级转诊中心接受治疗的186个患有非转移性UTUC的肾单位。
RNU、输尿管肾镜检查、经皮肿瘤切除术和节段性输尿管切除术。
采用对数秩检验和独立样本检验分析无复发生存率、无转移生存率（MFS）、总生存率（OS）、癌症特异性生存率（CSS）和肾功能。
RNU组的OS为71.1%，KSS组为81.9%。在根据EAU风险分层进行倾向权重匹配的队列中，两组的无进展生存率（PFS；RNU为96.0%；KSS为86.0%）、MFS（RNU为72.0%；KSS为84.0%）、CSS（RNU为84.0%；KSS为86.0%）和OS（RNU为76.0%；KSS为76.0%）均相似。干预后2年和5年时，肾功能未见显著差异。尽管该系列是迄今为止接受KSS治疗的（高风险）UTUC患者的最大队列，但不适合进行多变量分析。
分析RNU组和KSS组时，PFS、MFS、CSS和OS均具有可比性。风险因素均匀分布且高风险疾病占比很大的组的类似结果表明，当前的风险分层在区分低风险和高风险疾病方面可能不准确。
在本报告中，我们研究了一家专科医院中上尿路尿路上皮癌的结局。我们得出结论，保留肾单位手术和根治性肾输尿管切除术的结局具有可比性，且可能无法正确识别不良结局的风险因素。
