开放手术、腹腔镜手术与机器人辅助根治性肾输尿管切除术治疗上尿路尿路上皮癌的肿瘤学及围手术期结局比较：一项多中心、多国、倾向评分匹配分析
Comparing Oncological and Perioperative Outcomes of Open versus Laparoscopic versus Robotic Radical Nephroureterectomy for the Treatment of Upper Tract Urothelial Carcinoma: A Multicenter, Multinational, Propensity Score-Matched Analysis.
作者信息
Grossmann Nico C, Soria Francesco, Juvet Tristan, Potretzke Aaron M, Djaladat Hooman, Ghoreifi Alireza, Kikuchi Eiji, Mari Andrea, Khene Zine-Eddine, Fujita Kazutoshi, Raman Jay D, Breda Alberto, Fontana Matteo, Sfakianos John P, Pfail John L, Laukhtina Ekaterina, Rajwa Pawel, Pallauf Maximillian, Poyet Cédric, Cacciamani Giovanni E, van Doeveren Thomas, Boormans Joost L, Antonelli Alessandro, Jamil Marcus, Abdollah Firas, Ploussard Guillaume, Heidenreich Axel, Storz Enno, Daneshmand Siamak, Boorjian Stephen A, Rouprêt Morgan, Rink Michael, Shariat Shahrokh F, Pradere Benjamin
机构信息
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.
Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland.
出版信息
Cancers (Basel). 2023 Feb 23;15(5):1409. doi: 10.3390/cancers15051409.
OBJECTIVES
To identify correlates of survival and perioperative outcomes of upper tract urothelial carcinoma (UTUC) patients undergoing open (ORNU), laparoscopic (LRNU), and robotic (RRNU) radical nephroureterectomy (RNU).
METHODS
We conducted a retrospective, multicenter study that included non-metastatic UTUC patients who underwent RNU between 1990-2020. Multiple imputation by chained equations was used to impute missing data. Patients were divided into three groups based on their surgical treatment and were adjusted by 1:1:1 propensity score matching (PSM). Survival outcomes per group were estimated for recurrence-free survival (RFS), bladder recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS). Perioperative outcomes: Intraoperative blood loss, hospital length of stay (LOS), and overall (OPC) and major postoperative complications (MPCs; defined as Clavien-Dindo > 3) were assessed between groups.
RESULTS
Of the 2434 patients included, 756 remained after PSM with 252 in each group. The three groups had similar baseline clinicopathological characteristics. The median follow-up was 32 months. Kaplan-Meier and log-rank tests demonstrated similar RFS, CSS, and OS between groups. BRFS was found to be superior with ORNU. Using multivariable regression analyses, LRNU and RRNU were independently associated with worse BRFS (HR 1.66, 95% CI 1.22-2.28, = 0.001 and HR 1.73, 95%CI 1.22-2.47, = 0.002, respectively). LRNU and RRNU were associated with a significantly shorter LOS (beta -1.1, 95% CI -2.2-0.02, = 0.047 and beta -6.1, 95% CI -7.2-5.0, < 0.001, respectively) and fewer MPCs (OR 0.5, 95% CI 0.31-0.79, = 0.003 and OR 0.27, 95% CI 0.16-0.46, < 0.001, respectively).
CONCLUSIONS
In this large international cohort, we demonstrated similar RFS, CSS, and OS among ORNU, LRNU, and RRNU. However, LRNU and RRNU were associated with significantly worse BRFS, but a shorter LOS and fewer MPCs.
目的
确定接受开放性根治性肾输尿管切除术（ORNU）、腹腔镜根治性肾输尿管切除术（LRNU）和机器人辅助根治性肾输尿管切除术（RRNU）的上尿路尿路上皮癌（UTUC）患者的生存及围手术期结局的相关因素。
方法
我们进行了一项回顾性多中心研究，纳入了1990年至2020年间接受根治性肾输尿管切除术的非转移性UTUC患者。采用链式方程多重填补法对缺失数据进行填补。根据手术治疗方式将患者分为三组，并通过1:1:1倾向评分匹配（PSM）进行调整。估计每组的生存结局，包括无复发生存期（RFS）、无膀胱复发生存期（BRFS）、癌症特异性生存期（CSS）和总生存期（OS）。围手术期结局：评估各组之间的术中失血量、住院时间（LOS）以及总体（OPC）和主要术后并发症（MPC；定义为Clavien-Dindo>3）。
结果
纳入的2434例患者中，PSM后剩余756例，每组252例。三组具有相似的基线临床病理特征。中位随访时间为32个月。Kaplan-Meier和对数秩检验显示各组之间的RFS、CSS和OS相似。发现ORNU的BRFS更佳。使用多变量回归分析，LRNU和RRNU与更差的BRFS独立相关（HR分别为1.66，95%CI 1.22-2.28，P=0.001和HR 1.73，95%CI 1.22-2.47，P=0.002）。LRNU和RRNU与显著更短的LOS相关（β分别为-1.1，95%CI -2.2-0.02，P=0.047和β -6.1，95%CI -7.2-5.0，P<0.001）以及更少的MPC（OR分别为0.5，95%CI 0.31-0.79，P=0.003和OR 0.27，95%CI 0.16-0.46，P<0.001）。
结论
在这个大型国际队列中，我们证明了ORNU、LRNU和RRNU之间的RFS、CSS和OS相似。然而，LRNU和RRNU与显著更差的BRFS相关，但LOS更短且MPC更少。
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