Evaluating the Oncological Outcomes of Pure Laparoscopic Radical Nephroureterectomy Performed for Upper-Tract Urothelial Carcinoma Patients: A Multicenter Cohort Study Adjusted by Propensity Score Matching
Evaluating the Oncological Outcomes of Pure Laparoscopic Radical Nephroureterectomy Performed for Upper-Tract Urothelial Carcinoma Patients: A Multicenter Cohort Study Adjusted by Propensity Score Matching
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DOI：
10.1245/s10434-020-09046-9
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发表时间：
2020-08-25
影响因子：
3.7
通讯作者：
Oya, Mototsugu
中科院分区：
文献类型：
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作者：
Shigeta, Keisuke;Matsumoto, Kazuhiro;Oya, Mototsugu
目的评价单纯腹腔镜根治性肾输尿管切除术（p-LRNU）与传统LRNU（c-LRNU）治疗上尿路上皮癌（UTUC）的肿瘤学可行性。方法在503例接受RNU治疗的UTUC患者中，我们确定了219例接受c-LRNU（腹腔镜肾切除术联合开放式膀胱袖套切除术）的患者和72例接受p-LRNU（在完全腹腔镜下解剖肾脏、输尿管和膀胱袖套）的患者。我们采用了倾向评分（PS）匹配方法，以实现同质性与患者的背景。进行PS匹配调整的Cox回归分析，以评估影响肿瘤结局的风险因素。结果68例p-LRNU和68例c-LRNU患者匹配。总体而言，51例（37.0%）发生膀胱内复发（IVR），21例（15.4%）疾病复发，20例（14.7%）死亡。与接受c-LRNU的患者相比，接受p-LRNU的患者手术时间明显缩短，失血量减少。虽然两种方法的3年无复发生存率无显著差异，但在p-LRNU组中观察到非典型复发部位，包括脑、乙状结肠、阴道和腹膜。关于IVR，p-LRNU组的3年无IVR生存率为41.8%，显著低于c-LRNU组（66.6%，p = 0.004）。多变量分析表明，膀胱癌、输尿管癌和p-LRNU病史是后续IVR的独立风险因素。结论尽管p-LRNU的侵袭性较小，但由于肿瘤在膀胱内外的扩散，目前的技术可能会增加不典型疾病复发和随后IVR的发生率。
Purpose To evaluate the oncological feasibility of pure laparoscopic radical nephroureterectomy (p-LRNU) for upper tract urothelial carcinoma (UTUC) compared with conventional LRNU (c-LRNU) using a propensity-adjusted multi-institutional collaboration dataset. Methods Among the 503 UTUC patients who underwent RNU, we identified 219 who underwent c-LRNU (laparoscopic nephrectomy with open bladder cuff resection) and 72 who underwent p-LRNU (dissecting the kidney, ureter, and bladder cuff under complete laparoscopy). We adopted a propensity score (PS) matching method to achieve homogeneity with respect to patient backgrounds. PS matching-adjusted Cox-regression analysis was performed to evaluate the risk factors that influenced oncological outcomes. Results Sixty-eight p-LRNU and 68 c-LRNU patients were matched. Overall, 51 (37.0%) developed intravesical recurrence (IVR), 21 (15.4%) had disease recurrence, and 20 (14.7%) died. Patients who underwent p-LRNU had a significantly shorter operation time and less blood loss than those who underwent c-LRNU. Although no significant differences in 3-year recurrence-free survival were found between the two methods, atypical recurrence sites were observed in the p-LRNU group, including the brain, sigmoid colon, vagina, and peritoneum. Regarding IVR, the 3-year IVR-free survival rate was 41.8% in the p-LRNU group, which was significantly lower than that in the c-LRNU group (66.6%,p = 0.004). Multivariate analysis demonstrated that a history of bladder cancer, ureteral cancer, and p-LRNU were independent risk factors for subsequent IVR. Conclusion Although p-LRNU is less invasive, the current technique may increase the incidence of atypical disease recurrence and subsequent IVR due to extravesical and intravesical tumor dissemination.