Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Int Braz J Urol. 2023 Jul-Aug;49(4):469-478. doi: 10.1590/S1677-5538.IBJU.2023.0031.
To compare the effects of different combinations of radical nephroureterectomy (RNU) and bladder cuff excision (BCE) surgical procedures on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC).
This retrospective observational study included 452 patients who underwent RNU with BCE for UTUC between January 2010 and December 2020. The patients were classified into three groups based on different combinations of RNU and BCE surgical procedures: open RNU with open BCE (group 1, n=104), minimally invasive (MIS) RNU with open BCE (group 2, n=196), and MIS RNU with intracorporeal BCE (group 3, n=152). Data on demographics, body mass index, history, preoperative renal function, perioperative status, tumor characteristics, histopathology, and recurrence conditions were collected. Multivariate Cox regression analyses were performed to determine the impact of the surgical procedures on IVR. P-values < 0.05 were considered statistically significant.
After a median follow-up of 29.5 months, the IVR rate was 29.6% and the IVR-free survival rate was the lowest in group 2 (group 1 vs. group 2 vs. group 3: 69.0% vs. 55.1% vs. 67.5%; log-rank P=0.048). The overall survival rate was comparable among the three groups. Multivariate analysis revealed that group 2 had a significantly higher risk of IVR than group 1 (hazard ratio=1.949, 95% confidence interval=1.082-3.511, P=0.026), while groups 1 and 3 had similar risks.
For patients with UTUC, MIS RNU with open BCE is associated with a higher risk of IVR than open RNU with open BCE and MIS RNU with intracorporeal BCE.
比较根治性肾输尿管切除术（RNU）和膀胱袖状切除术（BCE）联合应用于上尿路尿路上皮癌（UTUC）患者的不同手术方案对膀胱内复发（IVR）的影响。
本回顾性观察性研究纳入了 2010 年 1 月至 2020 年 12 月期间接受 RNU 联合 BCE 治疗 UTUC 的 452 例患者。根据 RNU 和 BCE 手术的不同组合，将患者分为三组：开放 RNU 联合开放 BCE（第 1 组，n=104）、微创（MIS）RNU 联合开放 BCE（第 2 组，n=196）和 MIS RNU 联合经体腔内 BCE（第 3 组，n=152）。收集患者的人口统计学、体重指数、病史、术前肾功能、围手术期情况、肿瘤特征、组织病理学和复发情况等数据。采用多变量 Cox 回归分析确定手术方案对 IVR 的影响。P 值<0.05 为统计学显著。
中位随访 29.5 个月后，IVR 发生率为 29.6%，第 2 组的 IVR 无复发生存率最低（第 1 组 vs. 第 2 组 vs. 第 3 组：69.0% vs. 55.1% vs. 67.5%；对数秩 P=0.048）。三组患者的总生存率相当。多变量分析显示，第 2 组 IVR 的风险明显高于第 1 组（风险比=1.949，95%置信区间=1.082-3.511，P=0.026），而第 1 组和第 3 组的风险相似。
对于 UTUC 患者，MIS RNU 联合开放 BCE 与开放 RNU 联合开放 BCE 和 MIS RNU 联合经体腔内 BCE 相比，IVR 风险更高。
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