根治性肾输尿管切除术对初发IV期非转移性和转移性上尿路尿路上皮癌生存的影响
Survival Impact of Nephroureterectomy for De Novo Stage IV Nonmetastatic and Metastatic Upper Tract Urothelial Carcinoma.
作者信息
Lin Wei-Yu, Lin Meng-Hung, Yang Yao-Hsu, Chen Wen-Cheng, Huang Cih-En, Chen Miao-Fen, Wu Chun-Te
机构信息
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
出版信息
Front Surg. 2022 May 26;9:903123. doi: 10.3389/fsurg.2022.903123. eCollection 2022.
BACKGROUND
Whether nephroureterectomy (NU) provides survival benefits in patients with stage IV upper tract urothelial carcinoma (UTUC) remains unclear. We compared the effect of chemotherapy (CT) alone with that of CT combined with NU (CT + NU) on the overall survival (OS) of patients with stage IV nonmetastatic UTUC (nmUTUC) and metastatic UTUC (mUTUC).
PATIENTS AND METHODS
This multicenter retrospective cohort study included the data of patients with UTUC undergoing CT alone or CT + NU from the Chang Gung Cancer Database (2002-2015) and followed them until August 2017. OS and hazard ratios (HRs) were assessed using the Kaplan-Meier method and Cox proportional hazards model, respectively.
RESULTS
This study included 308 patients with stage IV UTUC, comprising 139 with nmUTUC and 169 with mUTUC. Moreover, 91 (74.6%) patients with nmUTUC and 31 (25.4%) patients with mUTUC received NU. The CT + NU group had a higher 3-year OS rate (41.0.% vs 16.7%, < 0.001), longer median OS duration (20.7 vs 9.0 months, < 0.001), and lower risk of death (HR, 0.48; 95% confidence interval, 0.36-0.66; < 0.001) than did the CT-alone group. Similarly, patients with mUTUC who underwent CT + NU had a longer median OS duration (25.0 vs 7.8 months, < 0.001) and lower risk of death (HR, 0.37; 95% confidence interval, 0.23-0.59; < 0.001) than did those who received CT alone.
CONCLUSION
Compared with CT alone, NU + CT can provide survival benefits to patients with nonmetastatic and metastatic stage IV UTUC.
背景
肾输尿管切除术（NU）对IV期上尿路尿路上皮癌（UTUC）患者是否具有生存获益尚不清楚。我们比较了单纯化疗（CT）与化疗联合NU（CT + NU）对IV期非转移性UTUC（nmUTUC）和转移性UTUC（mUTUC）患者总生存期（OS）的影响。
患者与方法
这项多中心回顾性队列研究纳入了长庚癌症数据库（2002 - 2015年）中接受单纯CT或CT + NU治疗的UTUC患者的数据，并对其进行随访直至2017年8月。分别采用Kaplan - Meier法和Cox比例风险模型评估OS和风险比（HRs）。
结果
本研究纳入了308例IV期UTUC患者，其中139例为nmUTUC，169例为mUTUC。此外，91例（74.6%）nmUTUC患者和31例（25.4%）mUTUC患者接受了NU。与单纯CT组相比，CT + NU组的3年OS率更高（41.0%对16.7%，<0.001），中位OS持续时间更长（20.7个月对9.0个月，<0.001），死亡风险更低（HR，0.48；95%置信区间，0.36 - 0.66；<0.001）。同样，接受CT + NU治疗的mUTUC患者的中位OS持续时间更长（25.0个月对7.8个月，<0.001），死亡风险更低（HR，0.37；95%置信区间，0.23 - 0.59；<0.001），而接受单纯CT治疗的患者则不然。
结论
与单纯CT相比，NU + CT可为非转移性和转移性IV期UTUC患者提供生存获益。
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