Yonese Ichiro, Ito Masaya, Waseda Yuma, Kobayashi Shuichiro, Toide Masahiro, Takazawa Ryoji, Koga Fumitaka
Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan.
Department of Urology, Tokyo Metropolitan Ohtuska Hospital, Tokyo 170-8476, Japan.
Cancers (Basel). 2022 Aug 17;14(16):3962. doi: 10.3390/cancers14163962.
Background: We hypothesized that diagnostic ureterorenoscopy (URS) may adversely affect prognosis in a subset of patients with high-risk upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). Methods: The present retrospective study included 143 patients with UTUC treated between 2010 and 2021 at two tertiary care hospitals, of whom 79 received URS prior to RNU. Subgroups were stratified by clinicopathological variables relevant to prognosis. The primary endpoint was to evaluate the prognostic impact of URS on overall survival (OS) and progression-free survival (PFS) after RNU. Results: During follow-up (median 54 months for survivors), 32 cases of all-cause mortality and 40 cases of progression were recorded. No significant difference was found in OS or PFS between patients with and without URS. Subgroup analysis demonstrated that URS was significantly associated with worse OS (p < 0.001) and PFS (p = 0.008) in 29 patients with non-papillary and ≥pT3 UTUC. Importantly, URS did not have any adverse effects on prognosis in 62 patients with papillary and ≤pT2 UTUC (p = 0.005). Conclusions: URS may adversely affect prognosis of UTUC patients, specifically non-papillary and ≥pT3 disease. URS may better be avoided in patients with high-risk UTUC features unless URS is necessary to diagnose UTUC. This study also corroborates the oncological safety of URS in those with low-risk UTUC.
我们推测，对于接受根治性肾输尿管切除术（RNU）的高危上尿路尿路上皮癌（UTUC）患者亚组，诊断性输尿管肾镜检查（URS）可能会对其预后产生不利影响。方法：本回顾性研究纳入了2010年至2021年期间在两家三级医疗中心接受治疗的143例UTUC患者，其中79例在RNU之前接受了URS。根据与预后相关的临床病理变量对亚组进行分层。主要终点是评估URS对RNU后总生存期（OS）和无进展生存期（PFS）的预后影响。结果：在随访期间（幸存者的中位随访时间为54个月），记录了32例全因死亡病例和40例病情进展病例。接受URS和未接受URS的患者在OS或PFS方面未发现显著差异。亚组分析表明，在29例非乳头状且≥pT3的UTUC患者中，URS与较差的OS（p < 0.001）和PFS（p = 0.008）显著相关。重要的是，在62例乳头状且≤pT2的UTUC患者中，URS对预后没有任何不利影响（p = 0.005）。结论：URS可能会对UTUC患者的预后产生不利影响，特别是对于非乳头状且≥pT3的疾病。对于具有高危UTUC特征的患者，除非诊断UTUC有必要进行URS，否则最好避免使用。本研究还证实了URS在低危UTUC患者中的肿瘤学安全性。
