Department of Urology, Sapporo Medical University School of Medicine, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan.
World J Urol. 2024 Nov 6;42(1):629. doi: 10.1007/s00345-024-05302-9.
The purpose of this study was to clarify the appropriate cystoscopic interval after nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC) using a hypothetical model.
A total of 155 patients who underwent NU in 15 years were retrospectively evaluated. Three hypothetical models for surveillance intervals were created: 3 (model 1), 6 (model 2) and 12 months (model 3). We superimposed these models on the actual surveillance of each patient and analyzed the observed timing of recurrence. The time from recurrence to scheduled cystoscopy (timeRCS) was defined as the time from recurrence to estimated cystoscopy. The gap risk ratio was calculated based on the average of timeRCS for model 1 at 0-1 year after surgery.
The median follow-up was 20.5 months. Intravesical recurrence was observed in 63 patients (40.6%). The 3-year intravesical recurrence-free survival rate in patients without a history of bladder cancer before NU was significantly higher than in those with a history of bladder cancer (61% vs. 42%, P = 0.034). The medians of timeRCS for models 1, 2, and 3 were 1.9, 2.9, and 8.4 months, respectively. The gap risk ratios for model 1 at 1-3 years, model 2 at 2-3 years for patients with a history of bladder cancer, and model 2 at 1-3 years for patients without a history of bladder cancer were less than 1.0.
Model analysis shows that the cystoscopic follow-up interval can be extended depending on the presence or absence of a history of bladder cancer and the time after NU.
本研究旨在通过假设模型明确上尿路上皮癌（UTUC）患者行肾输尿管切除术（NU）后的适当膀胱镜检查间隔。
回顾性评估了 15 年内接受 NU 的 155 例患者。创建了三种监测间隔的假设模型：3 个月（模型 1）、6 个月（模型 2）和 12 个月（模型 3）。我们将这些模型叠加在每个患者的实际监测上，并分析观察到的复发时间。从复发到计划行膀胱镜检查的时间（timeRCS）定义为从复发到预计膀胱镜检查的时间。根据术后 0-1 年内模型 1 的 timeRCS 平均值计算间隙风险比。
中位随访时间为 20.5 个月。63 例（40.6%）患者发生膀胱内复发。NU 前无膀胱癌病史的患者的 3 年膀胱内无复发生存率明显高于有膀胱癌病史的患者（61% vs. 42%，P=0.034）。模型 1、2 和 3 的 timeRCS 中位数分别为 1.9、2.9 和 8.4 个月。对于有膀胱癌病史的患者，模型 1 在 1-3 年、模型 2 在 2-3 年，以及无膀胱癌病史的患者，模型 2 在 1-3 年的间隙风险比均小于 1.0。
模型分析表明，膀胱镜检查的随访间隔可以根据膀胱癌病史的有无以及 NU 后的时间来延长。
