The Effect of Diagnostic Ureterorenoscopy on Intravesical Recurrence in Patients Undergoing Nephroureterectomy for Primary Upper Tract Urinary Carcinoma
The Effect of Diagnostic Ureterorenoscopy on Intravesical Recurrence in Patients Undergoing Nephroureterectomy for Primary Upper Tract Urinary Carcinoma
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DOI：
10.1159/000511650
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发表时间：
2020-12-02
影响因子：
1.6
通讯作者：
Bayazit, Yildirim
中科院分区：
文献类型：
--
作者：
Izol, Volkan;Deger, Mutlu;Bayazit, Yildirim
目的：本研究的目的是评估在根治性肾输尿管切除术（RNU）前进行诊断性输尿管镜检查（URS）对原发性上尿路尿路上皮癌（UTUC）患者膀胱内复发（IVR）的影响。材料与方法：回顾性分析2005年至2019年10个泌尿外科中心354例UTUC RNU患者。主要终点为RNU后发生IVR。将患者分为手术前尿潴留组（1组）和手术前无尿潴留组（2组）。比较RNU后IVR的发生率，并采用Cox比例风险模型评估IVR的潜在预测因素。结果：排除后共分析194例患者：1组n = 95(49.0%)， 2组n = 99（51.0%）。在第一组中，58例（61.1%）在URS期间进行了肿瘤活检和组织病理学确认。平均随访时间为39.17 +/- 39.3（12-250）个月。54例（27.8%）患者在RNU后记录IVR，膀胱内中位复发时间为10.0（3-144）个月。第1组的IVR率为38.9%，第2组为17.2% （p = 0.001）。在第1组中，术中活检患者的IVR率为43.1%，而诊断URS时未活检患者的IVR率为32.4% （p =0.29）。与1组相比，2组的膀胱内无复发生存期（IRFS）更长（2组和1组的中位IRFS分别为111个月和60个月（p< 0.001））。单因素分析显示，IRFS与URS的相关性显著高于RNU （HR: 2.9, 95% CI 1.65-5.41; p < 0.001）。在多变量分析中，RNU前URS （HR: 3.5, 95% CI 1.74-7.16; p < 0.001）被发现是IRFS的独立预后因素。结论：诊断性尿潴留与原发性UTUC RNU后较差的IRFS相关。是否进行肿瘤活检诊断尿毒症的决定应保留在这些信息可能影响进一步治疗决定的情况下。
Objective: The objective of this study is to evaluate the effect of diagnostic ureterorenoscopy (URS) prior to radical nephroureterectomy (RNU) on intravesical recurrence (IVR), in patients with primary upper urinary tract urothelial carcinoma (UTUC). Materials and Methods: Retrospective analysis of 354 patients, who underwent RNU for UTUC from 10 urology centers between 2005 and 2019, was performed. The primary endpoint was the occurrence of IVR after RNU. Patients were divided into URS prior to RNU (Group 1) and no URS prior to RNU (Group 2). Rates of IVR after RNU were compared, and a Cox proportional hazards model was used to evaluate potential predictors of IVR. Results: After exclusion, a total of 194 patients were analyzed: Group 1 n = 95 (49.0%) and Group 2 n = 99 (51.0%). In Group 1, a tumor biopsy and histopathological confirmation during URS were performed in 58 (61.1%). The mean follow-up was 39.17 +/- 39.3 (range 12-250) months. In 54 (27.8%) patients, IVR was recorded after RNU, and the median recurrence time within the bladder was 10.0 (3-144) months. IVR rate was 38.9% in Group 1 versus 17.2% in Group 2 (p = 0.001). In Group 1, IVR rate was 43.1% in those undergoing intraoperative biopsy versus 32.4% of patients without biopsy during diagnostic URS (p =0.29). Intravesical recurrence-free survival (IRFS) was longer in Group 2 compared to Group 1 (median IRFS was 111 vs. 60 months in Groups 2 and 1, respectively (p< 0.001)). Univariate analysis revealed that IRFS was significantly associated with URS prior to RNU (HR: 2.9, 95% CI 1.65-5.41; p < 0.001). In multivariate analysis, URS prior to RNU (HR: 3.5, 95% CI 1.74-7.16; p < 0.001) was found to be an independent prognostic factor for IRFS. Conclusion: Diagnostic URS was associated with the poor IRFS following RNU for primary UTUC. The decision for a diagnostic URS with or without tumor biopsy should be reserved for cases where this information might influence further treatment decisions.