Luo Zhenkai, Jiao Binbin, Su Caixia, Zhao Hang, Yan Yangxuanyu, Pan Yijin, Ren Jian, Zhang Guan, Ding Zhenshan
Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2023 Mar 22;13:1122877. doi: 10.3389/fonc.2023.1122877. eCollection 2023.
We aimed to evaluate the effect of the timing of diagnostic ureteroscopy (URS) on intravesical recurrence (IVR) following radical nephroureterectomy (RNU).
The clinical data of 220 patients with upper tract urothelial carcinoma (UTUC) treated with RNU at our center from June 2010 to December 2020 were retrospectively analyzed. According to the timing of the URS, all patients were divided into three groups: the no URS group, the 1-session group (diagnostic URS immediately followed by RNU), and the 2-session group (RNU after diagnostic URS). Additionally, we analyzed IVR-free survival (IVRFS) using the Kaplan-Meier and Cox proportional regression methods.
The median follow-up period of these 220 patents was 41 (range: 2-143) months. Among them, 58 patients developed IVR following RNU. Kaplan-Meier curve displayed a significantly higher IVR rate in both treatment groups than in the no-URS group (=0.025). In the subgroup of patients with renal pelvis cancer, the incidence of IVR was significantly higher in both treatment groups than in the group without URS (=0.006). In univariate Cox proportional regression analysis, the two treatment groups were risk factors for IVR compared to the no-URS group [=0.027, hazard ratio (HR): 1.93, 95% confidence interval (CI): 1.08-3.46]. The two-stage group (=0.032, HR: 1.98, 95% CI: 1.08-3.65), positive urine pathology (<0.001, HR: 8.12, 95% CI: 3.63-18.15), adjuvant chemotherapy (<0.001, HR: 0.20, 95% CI: 0.10-0.38), and positive margin (<0.0001, HR: 7.50, 95% CI: 2.44-23.08) were all identified as independent predictors in the multivariate.
This study revealed that delayed RNU following diagnostic URS may increase the risk of postoperative IVR in patients with UTUC, preoperatively positive uropathology, and positive surgical margin were risk factors for IVR after RNU, while early postoperative chemotherapy may effectively prevent IVR. Delay of RUN after URS could increase the risk of IVR.
我们旨在评估诊断性输尿管镜检查（URS）时机对根治性肾输尿管切除术（RNU）后膀胱内复发（IVR）的影响。
回顾性分析2010年6月至2020年12月在我院接受RNU治疗的220例上尿路尿路上皮癌（UTUC）患者的临床资料。根据URS时机，将所有患者分为三组：无URS组、1次检查组（诊断性URS后立即行RNU）和2次检查组（诊断性URS后行RNU）。此外，我们使用Kaplan-Meier法和Cox比例回归法分析无IVR生存期（IVRFS）。
这220例患者的中位随访期为41（范围：2 - 143）个月。其中，58例患者在RNU后发生IVR。Kaplan-Meier曲线显示，两个治疗组的IVR率均显著高于无URS组（P = 0.025）。在肾盂癌患者亚组中，两个治疗组的IVR发生率均显著高于无URS组（P = 0.006）。在单因素Cox比例回归分析中，与无URS组相比，两个治疗组均为IVR的危险因素[P = 0.027，风险比（HR）：1.93，95%置信区间（CI）：1.08 - 3.46]。两阶段组（P = 0.032，HR：1.98，95% CI：1.08 - 3.65）、尿病理阳性（P < 0.001，HR：8.12，95% CI：3.63 - 18.15）、辅助化疗（P < 0.001，HR：0.20，95% CI：0.10 - 0.38）和切缘阳性（P < 0.0001，HR：7.50，95% CI：2.44 - 23.08）在多因素分析中均被确定为独立预测因素。
本研究表明，诊断性URS后延迟行RNU可能增加UTUC患者术后IVR的风险，术前尿病理阳性和手术切缘阳性是RNU后IVR的危险因素，而术后早期化疗可能有效预防IVR。URS后延迟RUN会增加IVR的风险。
