仅位于输尿管下段的上尿路尿路上皮癌行淋巴结清扫术的益处：一项双中心回顾性队列研究
Benefits of lymphadenectomy for upper tract urothelial carcinoma only located in the lower ureter: a bicentre retrospective cohort study.
作者信息
Cui Yupeng, Lu Youyi, Wu Jitao, Quan Changyi
机构信息
Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China.
Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.
出版信息
Front Oncol. 2023 Apr 14;13:1115830. doi: 10.3389/fonc.2023.1115830. eCollection 2023.
BACKGROUND
Upper tract urothelial carcinoma (UTUC) is a rare and highly malignant urothelial tumor originating from the renal pelvis and ureter associated with poor prognosis. It has been established that 70% of ureteral tumors occur in the lower ureter. Radical nephroureterectomy (RNU) with ipsilateral bladder cuff excision is regarded as the standard treatment for UTUC. Current evidence supports the role of lymph node dissection (LND) in determining tumor staging, but no consensus has been reached on the potential survival benefits. The present study retrospectively analyzed cases of UTUC limited to the lower ureter to evaluate the survival benefits of LND during RNU.
METHODS
The present study retrospectively analyzed data from patients with UTUC limited to the lower ureter from two medical centers from 2000 to 2016 and assessed the survival outcomes, including recurrence-free survival (RFS) and cancer specific survival (CSS). During subgroup analysis, we stratified by pathological tumor (pT) stages and postoperative adjuvant chemotherapy (AC).
RESULTS
The study cohort included 297 patients separated into LND (n=111) and non-LND (n=186) groups. The two groups were comparable except for the pathological N stage. The LND group was associated with superior survival in terms of RFS (27.0% vs. 18.3%, p=0.044) and CSS (53.2 vs. 39.8%, p=0.031) compared to the non-LND group (n=186). In pT2-4 patients, the LND group was associated with better 3-year RFS (50.5% vs. 32.3%, p<0.05), 5-year RFS (29.7% vs. 12.0%, p<0.05), and overall RFS (18.7% vs. 6.0%, p<0.05) than the non-LND group. Besides, the LND group was associated with a significantly better 3-year CSS (68.1% vs. 49.6%, p=0.003), 5-year CSS (51.6% vs. 30.8%, p<0.05) and overall CSS (45.1% vs. 24.1%, p<0.05). In patients that underwent AC, the LND group had better survival benefits in terms of RFS (29.4 vs. 16.7%, p=0.023) and CSS (52.9% vs. 40.5%, p=0.038) compared to the non-LND group.
CONCLUSION
LND has survival benefits in patients with UTUC localized to the lower ureter, especially for≥pT stage UTUC and AC cohorts. Overall, the therapeutic effect of LND in UTUC cannot be replaced by AC.
背景
上尿路尿路上皮癌（UTUC）是一种罕见的高恶性尿路上皮肿瘤，起源于肾盂和输尿管，预后较差。已证实70%的输尿管肿瘤发生在输尿管下段。根治性肾输尿管切除术（RNU）联合同侧膀胱袖口切除术被视为UTUC的标准治疗方法。目前的证据支持淋巴结清扫（LND）在确定肿瘤分期中的作用，但对于其潜在的生存获益尚未达成共识。本研究回顾性分析了局限于输尿管下段的UTUC病例，以评估RNU期间LND的生存获益。
方法
本研究回顾性分析了2000年至2016年来自两个医疗中心的局限于输尿管下段的UTUC患者的数据，并评估了生存结局，包括无复发生存期（RFS）和癌症特异性生存期（CSS）。在亚组分析中，我们按病理肿瘤（pT）分期和术后辅助化疗（AC）进行分层。
结果
研究队列包括297例患者，分为LND组（n = 111）和非LND组（n = 186）。除病理N分期外，两组具有可比性。与非LND组（n = 186）相比，LND组在RFS（27.0%对18.3%，p = 0.044）和CSS（53.2对39.8%，p = 0.031）方面具有更好的生存情况。在pT2 - 4期患者中，LND组在3年RFS（50.5%对32.3%，p < 0.05）、5年RFS（29.7%对12.0%，p < 0.05）和总体RFS（18.7%对6.0%，p < 0.05）方面均优于非LND组。此外，LND组在3年CSS（68.1%对49.6%，p = 0.003）、5年CSS（51.6%对30.8%，p < 0.05）和总体CSS（45.1%对24.1%，p < 0.05）方面也明显更好。在接受AC的患者中，与非LND组相比，LND组在RFS（29.4对16.7%，p = 0.023）和CSS（52.9%对40.5%，p = 0.038）方面具有更好的生存获益。
结论
LND对局限于输尿管下段的UTUC患者有生存获益，特别是对于≥pT期UTUC和AC队列患者。总体而言，LND在UTUC中的治疗效果不能被AC替代。
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