Impact of diagnostic ureteral catheterization on intravesical tumour recurrence following radical nephroureterectomy for upper tract urothelial carcinoma
Impact of diagnostic ureteral catheterization on intravesical tumour recurrence following radical nephroureterectomy for upper tract urothelial carcinoma
复制标题
诊断性输尿管插管对上尿路尿路上皮癌根治性肾输尿管切除术后膀胱内肿瘤复发的影响
作者：
Ichiro Yonese;Masaya Ito;Y. Waseda;Shuichiro Kobayashi;Masahiro Toide;R. Takazawa;F. Koga
研究即使是上尿路的微创诊断程序，如输尿管导管插入术（UCath），是否也会显著增加接受根治性肾输尿管切除术（RNU）治疗的上尿路尿路上皮癌（UTUC）患者的膀胱内复发（IVR）风险。目前的回顾性研究招募了2010年至2021年期间在两家三级医院接受UTUC的163名患者。主要终点是UCath和无IVRFS（IVRFS）之间的相关性。次要终点是输尿管肾镜检查（URS）和URS活检（URSBx）与IVRFS的相关性。使用有向无环图（DAG）指导的多变量模型调整潜在混杂因素。在163例患者中，分别有128例（79%）、88例（54%）和67例（41%）接受了UCath、URS和URSBx。URS与UCath同时进行。在随访期间（中位数：47个月），62例患者发生IVR（5年IVRFS率：52%）。DAG包括并发膀胱癌、肿瘤大小、肾积水、阳性细胞学检查和多个UTUC，作为UCath和IVR之间相关性的潜在混杂因素。DAG引导和逐步多变量模型均显示UCath和IVR之间存在显著相关性（风险比：17.8; P < 0.001）。在75例未接受URS的患者中，UCath也与IVRFS缩短相关（P < 0.001）。相反，在分别接受UCath和URS的患者中，URS和URSBx与IVR无关。任何上尿路的诊断操作，即使是像UCath这样的微创手术，都可能给UTUC患者带来RNU后IVR的风险。
To investigate whether even a minimally invasive diagnostic procedure for the upper tract such as ureteral catheterization (UCath) may substantially increase the risk of intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). The present, retrospective study enrolled 163 patients undergoing RNU for UTUC between 2010 and 2021 at two, tertiary care hospitals. The primary endpoint was the association between UCath and IVR-free survival (IVRFS). The secondary endpoints were the association of ureterorenoscopy (URS) and URS biopsy (URSBx) with IVRFS. Directed acyclic graph (DAG)-guided multivariable models were used to adjust for potential confounders. Of the 163 patients, 128 (79%), 88 (54%), and 67 (41%) received UCath, URS, and URSBx, respectively. URS was performed concurrently with UCath. During the follow-up period (median: 47 months), IVR developed in 62 patients (5-year IVRFS rate: 52%). A DAG included concurrent bladder cancer, tumour size, hydronephrosis, positive cytology, and multiple UTUCs as potential confounders of the association between UCath and IVR. Both DAG-guided and stepwise multivariable models revealed a significant association between UCath and IVR (hazard ratio: 17.8; P < 0.001). UCath was also associated with shorter IVRFS in a subset of 75 patients who had not received URS (P < 0.001). In contrast, URS and URSBx were not associated with IVR in patients who had received UCath and URS, respectively. Any diagnostic manipulations of the upper urinary tract, even a minimally invasive procedure like UCath, could confer a risk of post-RNU IVR in UTUC patients.
影响因子：
50.3
作者：
Fujii, Yoichi;Sato, Yusuke;Suzuki, Hiromichi;Kakiuchi, Nobuyuki;Yoshizato, Tetsuichi;Lenis, Andrew T.;Maekawa, Shigekatsu;Yokoyama, Akira;Takeuchi, Yasuhide;Inoue, Yoshikage;Ochi, Yotaro;Shiozawa, Yusuke;Aoki, Kosuke;Yoshida, Kenichi;Kataoka, Keisuke;Nakagawa, Masahiro M.;Nannya, Yasuhito;Makishima, Hideki;Miyakawa, Jimpei;Kawai, Taketo;Morikawa, Teppei;Shiraishi, Yuichi;Chiba, Kenichi;Tanaka, Hiroko;Nagae, Genta;Sanada, Masashi;Sugihara, Eiji;Sato, Taka-Aki;Nakagawa, Tohru;Fukayama, Masashi;Ushiku, Tetsuo;Aburatani, Hiroyuki;Miyano, Satoru;Coleman, Jonathan A.;Homma, Yukio;Solit, David B.;Kume, Haruki;Ogawa, Seishi
通讯作者：
Ogawa, Seishi