Department of Urology, Postal Hospital, Taipei, Taiwan; Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan.
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
Asian J Surg. 2023 Aug;46(8):3058-3065. doi: 10.1016/j.asjsur.2022.10.046. Epub 2022 Oct 29.
Endoscopic management of upper tract urothelial cancer (UTUC) is an important treatment option for low risk UTUC. Although Taiwan is an endemic area for UTUC, endoscopic treatment outcomes in Taiwan are frequently under- reported.
This study retrospectively reviewed the treatment outcomes of endoscopic management for clinically localized UTUC. Patients with biopsy or washing cytology confirmed UTUC who underwent endoscopic or percutaneous management with a curative intent were retrospectively reviewed for eligibility of analysis. Those cases without pre-intervention confirmed UTUC, and metastatic or nodal disease at diagnosis were excluded.
In total, 307 patients who underwent endoscopic management were reviewed and 279 cases were eligible for final analysis. With a median follow-up of 44.3 months (inter-quartile range (IQR): 23.4-76.4 months), 117 cases (46.4%) were endoscopic cured after median one session (range:1-8; IQR:1-2) of endoscopic treatment. Those endoscopic cured UTUC was associated with more small-sized tumor, more low-grade biopsied-histology, less concomitant bladder UC and less pre-operative hydronephrosis. In addition, 201(79.7%) cases among 252 cases with confirmed oncological outcome were free of UTUC at the end of follow-up and only 43 (17%) patients had a UTUC related mortality. Salvage RNU offered a better tumor free survival rate (92% vs. 77.5%) than those without salvage RNU in those UTUC refractory to endoscopic management. In multivariable analyses, pre-operative hydronephrosis was the independent risk factor for OS. Multiplicity and concomitant bladder UC were independent risk factors for DFS.
We confirmed the consistent safety and efficacy of endoscopic management of clinical localized UTUC in a highly UTUC endemic area like Taiwan. Early salvage RNU is mandatory in those UTUC refractory to endoscopic management in prevention of UTUC related death.
内镜治疗上尿路尿路上皮癌（UTUC）是低危 UTUC 的重要治疗选择。尽管台湾是 UTUC 的流行地区，但台湾的内镜治疗结果经常报道不足。
本研究回顾性分析了内镜治疗局限性 UTUC 的治疗效果。对经活检或冲洗细胞学检查确诊为 UTUC 并接受内镜或经皮治疗（有治愈意向）的患者进行回顾性分析，以确定是否符合入选标准。排除无术前确诊的 UTUC 以及诊断时存在转移或淋巴结疾病的患者。
共纳入 307 例行内镜治疗的患者，279 例符合最终分析标准。中位随访时间为 44.3 个月（四分位间距（IQR）：23.4-76.4 个月），117 例（46.4%）患者经 1 次内镜治疗（范围：1-8 次；IQR：1-2 次）后内镜治愈。内镜治愈的 UTUC 与肿瘤体积较小、组织学分级较低、合并膀胱癌和术前肾积水较少有关。此外，在 252 例有明确肿瘤学结果的患者中，201 例（79.7%）在随访结束时无 UTUC，仅 43 例（17%）患者因 UTUC 相关死亡。对于那些对内镜治疗无反应的 UTUC，挽救性肾输尿管切除术（RNU）提供了更好的无肿瘤生存率（92% vs. 77.5%）。多变量分析显示，术前肾积水是 OS 的独立危险因素。多发性和合并膀胱癌是 DFS 的独立危险因素。
我们在像台湾这样的高度 UTUC 流行地区证实了内镜治疗局限性 UTUC 的安全性和疗效一致。对于那些对内镜治疗无反应的 UTUC，早期进行挽救性 RNU 是预防 UTUC 相关死亡的必要措施。
