Gallioli Andrea, Uleri Alessandro, Verri Paolo, Tedde Alessandro, Mertens Laura S, Moschini Marco, Del Giudice Francesco, Soria Francesco, Laukhtina Ekaterina, Subiela José Daniel, Krajewski Wojciech, D'Andrea David, Mari Andrea, Marcq Gautier, Mori Keiichiro, Teoh Jeremy, Afferi Luca, Albisinni Simone, Sanguedolce Francesco, Palou Joan, Breda Alberto, Pradere Benjamin
Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain.
Department of Urology, Fundació Puigvert, Barcelona, Spain.
Eur Urol Focus. 2025 Feb 1. doi: 10.1016/j.euf.2025.01.009.
Data about the mid- and long-term oncologic outcomes of endoscopic kidney-sparing surgery (eKSS) for upper tract urothelial carcinoma (UTUC) are scarce. Therefore, we aimed to summarize the current evidence on the oncologic outcomes of eKSS for UTUC.
A literature search was conducted to identify reports published until May 2024. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The outcomes were the following: recurrence-free (RFS), intravesical recurrence-free (IV-RFS), progression-free (PFS), cancer-specific (CSS), and overall (OS) survival.
We found 56 studies (n = 52 retrospective) that met our inclusion criteria (n = 2862 patients). The 1-, 2-, 5-, and 10-yr OS rates were 96%, 87%, 80%, and 42%, respectively. The 1-, 2-, 5-, and 10-yr CSS rates were 97%, 89%, 82%, and 69%, respectively. RFS rates at 1, 2, and 5 yr were 69%, 55%, and 45%, respectively. IV-RFS rates at 1, 2, and 5 yr were 80%, 65%, and 64%, respectively. PFS rates at 2 and 5 yr were 75% and 69%, respectively. In low-grade UTUC, OS rates at 2 and 5 yr were 93% and 77%, respectively. The 2- and 5-yr CSS rates were 98% and 88%, respectively. At 2 yr, RFS, IV-RFS, and PFS were 52%, 54%, and 94%, respectively. For high-grade UTUC, only three studies reported data on 2-yr RFS, which was 34%. The main limitation is the heterogeneity found across the studies.
Local recurrence, bladder recurrence, and progression of UTUC occur mainly within 2 yr after eKSS. After 5-yr follow-up, OS and CSS drop, while the risk of local recurrence is non-negligible.
关于上尿路尿路上皮癌（UTUC）的内镜保肾手术（eKSS）的中长期肿瘤学结局的数据较少。因此，我们旨在总结目前关于eKSS治疗UTUC的肿瘤学结局的证据。
进行文献检索以识别截至2024年5月发表的报告。遵循系统评价和Meta分析的首选报告项目指南来识别符合条件的研究。结局指标如下：无复发生存期（RFS）、无膀胱内复发生存期（IV-RFS）、无进展生存期（PFS）、癌症特异性生存期（CSS）和总生存期（OS）。
我们发现56项研究（n = 52项回顾性研究）符合我们的纳入标准（n = 2862例患者）。1年、2年、5年和10年的OS率分别为96%、87%、80%和42%。1年、2年、5年和10年的CSS率分别为97%、89%、82%和69%。1年、2年和5年的RFS率分别为69%、55%和45%。1年、2年和5年的IV-RFS率分别为80%、65%和64%。2年和5年的PFS率分别为75%和69%。在低级别UTUC中，2年和5年的OS率分别为93%和77%。2年和5年的CSS率分别为98%和88%。在2年时，RFS、IV-RFS和PFS分别为52%、54%和94%。对于高级别UTUC，只有三项研究报告了2年RFS的数据，为34%。主要局限性是研究间存在异质性。
UTUC的局部复发、膀胱复发和进展主要发生在eKSS后的2年内。经过5年随访，OS和CSS下降，而局部复发风险不可忽视。
