Department of Urology, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Health Management, Shanghai Electric Power Hospital, Shanghai, China.
Sci Rep. 2024 Oct 23;14(1):25090. doi: 10.1038/s41598-024-77117-y.
This study evaluates the survival outcomes of segmental ureterectomy (SU) combined with chemotherapy in patients with high-grade non-metastatic ureteral cancer (UC) using data from the SEER database. A total of 1757 patients with Grade III-IV non-metastatic UC were analyzed. Overall survival (OS) was assessed through Kaplan-Meier analysis, and independent prognostic factors were identified via Cox regression. A Nomogram model was developed and evaluated using the concordance index, area under the time-dependent ROC curve, calibration curves, and decision curve analysis. The 1-, 3-, and 5-year OS rates were 82.8%, 55.6%, and 42.8%, respectively. Age, treatment protocol, T stage, and N stage were significant prognostic factors. Both SU + chemotherapy and radical nephroureterectomy (RNU) + chemotherapy demonstrated comparable survival outcomes, outperforming surgery alone, particularly in patients aged 70 and older. The Nomogram demonstrated high predictive accuracy and clinical utility. These findings suggest that SU + chemotherapy offers survival benefits similar to RNU + chemotherapy, making it a viable option, especially for elderly patients or those with impaired renal function.
本研究利用 SEER 数据库中的数据评估了高级别非转移性输尿管癌（UC）患者行节段性输尿管切除术（SU）联合化疗的生存结局。共分析了 1757 例 III-IV 级非转移性 UC 患者。通过 Kaplan-Meier 分析评估总生存期（OS），并通过 Cox 回归确定独立预后因素。通过一致性指数、时间依赖性 ROC 曲线下面积、校准曲线和决策曲线分析开发和评估了列线图模型。1、3 和 5 年 OS 率分别为 82.8%、55.6%和 42.8%。年龄、治疗方案、T 分期和 N 分期是显著的预后因素。SU+化疗和根治性肾输尿管切除术（RNU）+化疗的生存结局相当，优于单纯手术，特别是在 70 岁及以上的患者中。列线图显示出较高的预测准确性和临床实用性。这些发现表明，SU+化疗可提供与 RNU+化疗相似的生存获益，是一种可行的选择，尤其适用于老年患者或肾功能受损的患者。
