Endoscopic Treatment for Large Multifocal Upper Tract Urothelial Carcinoma
Endoscopic Treatment for Large Multifocal Upper Tract Urothelial Carcinoma
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DOI：
10.1097/ju.0000000000001505
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发表时间：
2021-04-01
影响因子：
6.6
通讯作者：
Kleinmann, Nir
中科院分区：
文献类型：
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作者：
Shvero, Asaf;Abu-Ghanem, Yasmin;Kleinmann, Nir
目的：我们回顾了低级别上尿路尿路上皮癌内镜治疗的肿瘤学和手术结果，并评估了肿瘤大小，位置和多灶性的预后意义。材料和方法：我们回顾性分析了2014年至2019年期间在我们机构接受内镜治疗的所有患者。用双激光发生器治疗肿瘤，该发生器交替产生钬激光和钕激光。严格的输尿管镜随访方案进行。我们寻找结果与肿瘤大小、位置或多灶性之间的关系，以及局部复发和进展时间的预测因素。结果：该队列包括59例患者（62个肾单位），27%的肿瘤为多灶性，40%>2 cm。中位随访时间为22个月（IQR 11-41），输尿管镜检查的中位次数为5.5（4-9）。在初次手术后中位6.5个月时，在46个肾单位（74.1%）中观察到局部复发。4例患者（6.4%）发生疾病进展并接受根治性手术：2例发生病理进展，2例发生快速和高体积局部复发，1例后来发生转移性疾病。无进展率为93.2%。肿瘤位于肾脏（p=0.03，HR 1.95）和多灶性（p=0.005，HR 3.25）可显著预测局部复发时间。结论：输尿管镜治疗大型、多灶性、低级别上尿路上皮癌是可行的，不涉及重大并发症，具有良好的短期肿瘤学结局，无进展生存率为93.2%。肿瘤位于肾脏和多灶性产生较短的时间局部复发，但没有进展。
Purpose: We reviewed the oncologic and surgical outcomes of endoscopic treatments for low grade upper tract urothelial carcinoma, and assessed the prognostic significance of tumor size, location and multifocality.Materials and Methods: We retrospectively reviewed all patients who underwent endoscopic treatment for low grade upper tract urothelial carcinoma at our institution between 2014 and 2019. Tumors were treated with a dual laser generator, which alternately produces holmium and neodymium lasers. A stringent ureteroscopic followup protocol was conducted. We looked for an association between outcome and tumor size, location or multifocality, and for predictive factors for time to local recurrence and progression.Results: The cohort included 59 patients (62 renal units), 27% of tumors were multifocal and 40% were >2 cm. The median followup time was 22 months (IQR 11-41), and the median number of ureteroscopies was 5.5 (4-9). Local recurrence was observed in 46 renal units (74.1%) at a median of 6.5 months after initial surgery. Four patients (6.4%) developed disease progression and were referred for radical surgery: 2 had pathological progression and 2 had a rapid and high volume local recurrence, and 1 later developed metastatic disease. The progression-free rate was 93.2%. Tumor location in kidney (p=0.03, HR 1.95) and multifocality (p=0.005, HR 3.25) significantly predicted time to local recurrence. No factor predicted time to progression.Conclusions: Ureteroscopic treatment of large, multifocal, low grade upper tract urothelial carcinoma is feasible, does not involve significant complications and has good short-term oncologic outcomes, with a 93.2% progression-free survival rate. Tumors located in the kidney and multifocality yielded shorter time to local recurrence but not progression.