Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China.
Radiat Oncol. 2023 Jul 18;18(1):120. doi: 10.1186/s13014-023-02303-7.
The purpose of this study was to evaluate the efficacy of postoperative adjuvant radiotherapy for patients with upper tract urothelial carcinoma (UTUC) who underwent kidney-sparing surgery (KSS).
We retrospectively reviewed the clinical records of 31 patients with primary UTUC who underwent kidney-sparing surgery (KSS) and who were treated with adjuvant radiotherapy at our center between October 1998 and May 2017. Statistical analyses were performed with SPSS 23.0. The primary endpoints of this study included overall survival (OS) and local recurrence-free survival (LRFS); the secondary endpoints were disease-free survival (DFS) and treatment-related toxicity.
The median follow-up was 58.4 months (range, 12.7-185.3 months), and the median local recurrence time was 59.0 months (range, 7.0-185 months). All of the patients completed radiotherapy on schedule, and no grade 3-4 late-stage reaction was observed. The estimated 5-year and 10-year OS, DFS and LRFS rates of the patients were 64.0%, 61.1%, 69.6% and 48.0%, 40.9%, 64.6%, respectively. Univariate analysis showed that age (χ2 = 4.224, P = 0.040), R0 resection (χ2 = 3.949, P = 0.047), and early stage (I + II) (χ2 = 6.515, P = 0.011) were associated with good OS; DFS benefit in early stage patients (χ2 = 6.151, P = 0.013) and age<70 years old (χ2 = 5.091, P = 0.024). Patients with distal ureteral segments had better LRFS than patients with proximal ureteral cancer (χ2 = 5.248, P = 0.022). However, multivariate analysis showed that age was the only factor of OS (χ2 = 4.099, P = 0.043).
Adjuvant radiotherapy is safe and tolerated, and LRFS was superior in middle and distal ureteral cancer than in proximal ureteral cancer.
本研究旨在评估接受保肾手术（KSS）的上尿路尿路上皮癌（UTUC）患者术后辅助放疗的疗效。
我们回顾性分析了 1998 年 10 月至 2017 年 5 月期间在我中心接受保肾手术（KSS）并接受辅助放疗的 31 例原发性 UTUC 患者的临床记录。采用 SPSS 23.0 进行统计学分析。本研究的主要终点包括总生存（OS）和局部无复发生存（LRFS）；次要终点包括无病生存（DFS）和治疗相关毒性。
中位随访时间为 58.4 个月（范围，12.7-185.3 个月），中位局部复发时间为 59.0 个月（范围，7.0-185 个月）。所有患者均按时完成放疗，未观察到 3-4 级晚期反应。患者的 5 年和 10 年 OS、DFS 和 LRFS 估计率分别为 64.0%、61.1%、69.6%和 48.0%、40.9%、64.6%。单因素分析显示，年龄（χ2=4.224，P=0.040）、R0 切除（χ2=3.949，P=0.047）和早期（I+II 期）（χ2=6.515，P=0.011）与良好的 OS 相关；早期患者的 DFS 获益（χ2=6.151，P=0.013）和年龄<70 岁（χ2=5.091，P=0.024）与 DFS 相关。远端输尿管段患者的 LRFS 优于近端输尿管癌患者（χ2=5.248，P=0.022）。然而，多因素分析显示，年龄是 OS 的唯一因素（χ2=4.099，P=0.043）。
辅助放疗安全耐受，中下段输尿管癌的 LRFS 优于上段输尿管癌。
