Paciotti Marco, Alkhatib Khalid Y, Nguyen David-Dan, Yim Kendrick, Lipsitz Stuart R, Mossanen Matthew, Casale Paolo, Pierorazio Phillip M, Kibel Adam S, Trinh Quoc-Dien, Buffi Nicoló Maria, Lughezzani Giovanni, Cole Alexander P
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA.
Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Cancers (Basel). 2023 Feb 21;15(5):1373. doi: 10.3390/cancers15051373.
Segmental ureterectomy (SU) is an alternative to radical nephroureterectomy (RNU) in the treatment of upper-tract urothelial carcinoma (UTUC) of the ureter. SU generally preserves renal function, at the expense of less intensive cancer control. We aim to assess whether SU is associated with inferior survival compared to RNU. Using the National Cancer Database (NCDB), we identified patients diagnosed with localized UTUC of the ureter between 2004-2015. We used a propensity-score-overlap-weighted (PSOW) multivariable survival model to compare survival following SU vs. RNU. PSOW-adjusted Kaplan-Meier curves were generated and we performed a non-inferiority test of overall survival. A population of 13,061 individuals with UTUC of the ureter receiving either SU or RNU was identified; of these, 9016 underwent RNU and 4045 SU. Factors associated with decreased likelihood of receiving SU were female gender (OR, 0.81; 95% CI, 0.75-0.88; < 0.001), advanced clinical T stage (cT4) (OR, 0.51; 95% CI, 0.30-0.88; = 0.015), and high-grade tumor (OR, 0.76; 95% CI, 0.67-0.86; < 0.001). Age greater than 79 years was associated with increased probability of undergoing SU (OR, 1.18; 95% CI, 1.00-1.38; = 0.047). There was no statistically significant difference in OS between SU and RNU (HR, 0.98; 95% CI, 0.93-1.04; = 0.538). SU was not inferior to RNU in PSOW-adjusted Cox regression analysis ( < 0.001 for non-inferiority). In weighted cohorts of individuals with UTUC of the ureter, the use of SU was not associated with inferior survival compared to RNU. Urologists should continue to utilize SU in appropriately selected patients.
节段性输尿管切除术（SU）是根治性肾输尿管切除术（RNU）治疗输尿管上段尿路上皮癌（UTUC）的一种替代方法。SU通常能保留肾功能，但对癌症的控制力度较弱。我们旨在评估与RNU相比，SU是否与较差的生存率相关。利用国家癌症数据库（NCDB），我们确定了2004年至2015年间被诊断为局限性输尿管UTUC的患者。我们使用倾向评分重叠加权（PSOW）多变量生存模型来比较SU与RNU后的生存率。生成了PSOW调整后的Kaplan-Meier曲线，并进行了总生存的非劣效性检验。确定了13061名接受SU或RNU治疗的输尿管UTUC患者；其中，9016例行RNU，4045例行SU。与接受SU可能性降低相关的因素包括女性（OR，0.81；95%CI，0.75-0.88；<0.001）、临床T分期晚期（cT4）（OR，0.51；95%CI，0.30-0.88；=0.015）和高级别肿瘤（OR，0.76；95%CI，0.67-0.86；<0.001）。年龄大于79岁与接受SU的概率增加相关（OR，1.18；95%CI，1.00-1.38；=0.047）。SU与RNU的总生存无统计学显著差异（HR，0.98；95%CI，0.93-1.04；=0.538）。在PSOW调整的Cox回归分析中，SU不劣于RNU（非劣效性<0.001）。在输尿管UTUC患者的加权队列中，与RNU相比，使用SU与较差的生存率无关。泌尿外科医生应继续在适当选择的患者中使用SU。
