Risk of Intravesical Recurrence After Ureteroscopic Biopsy for Upper Tract Urothelial Carcinoma: Does the Location Matter?
Risk of Intravesical Recurrence After Ureteroscopic Biopsy for Upper Tract Urothelial Carcinoma: Does the Location Matter?
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DOI：
10.1089/end.2016.0611
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发表时间：
2017-03-01
影响因子：
2.7
通讯作者：
Jeong, In Gab
中科院分区：
文献类型：
--
作者：
Yoo, Sangjun;You, Dalsan;Jeong, In Gab
简介：探讨上尿路上皮癌根治性肾输尿管切除术前输尿管镜活检（URS-Bx）对膀胱内复发（IVR）的影响。患者和方法：在1998年至2012年期间接受根治性肾输尿管切除术治疗UTUC的515例患者中，387例患者纳入分析。69例患者（17.8%）进行了URS-Bx。根据肿瘤位置对患者进行分层，并在调整其他临床病理变量后评价URS-Bx对IVR的影响。结果：163例患者发生IVR，发生率为42.1%。根据URS-Bx，总体患者组的术后5年无IVR生存率无显著差异（54.0% vs 39.3%，p=0.056）。在肾盂肿瘤患者中，URS-Bx患者的无IVR概率低于无URS-Bx患者（39.6% vs 62.2%，p=0.012），尽管输尿管肿瘤患者的无IVR生存率相当（36.7% vs 45.8%，p=0.946）。在多变量分析中，既往膀胱肿瘤（风险比[HR]，1.65; p=0.016）是所有患者IVR的显著风险因素，输尿管肿瘤位置（HR，1.35; p=0.071）与IVR相关，但未达到统计学显著性。在肾盂肿瘤患者中，URS-Bx HR，1.98; p=0.020是IVR的唯一风险因素。然而，URS-Bx与输尿管肿瘤患者的IVR无关，尽管既往膀胱肿瘤HR为1.74; p=0.028是IVR的风险因素。结论：URS-Bx是肾盂肿瘤患者IVR的重要风险因素，如果其他检查不确定，应在充分考虑后对这些患者进行。
Introduction: To investigate whether ureteroscopic biopsy (URS-Bx) for upper tract urothelial carcinoma (UTUC) before radical nephroureterectomy affects intravesical recurrence (IVR). Patients and Methods: Of the 515 patients receiving radical nephroureterectomy for UTUC between 1998 and 2012, 387 patients were included for the analysis. URS-Bx was performed in 69 patients (17.8%). Patients were stratified according to tumor location, and the impact of URS-Bx on IVR was evaluated after adjusting for other clinicopathologic variables. Results: IVR occurred in 163 patients (42.1%). The postoperative 5-year IVR-free survival was not significantly different according to URS-Bx in the overall patient group (54.0% vs 39.3%, p=0.056). In patients with renal pelvic tumor, IVR-free probability was lower in patients with URS-Bx than in patients without URS-Bx (39.6% vs 62.2%, p=0.012), although IVR-free survival in patients with ureteral tumor was equivalent (36.7% vs 45.8%, p=0.946). In multivariate analysis, previous bladder tumors (hazard ratio [HR], 1.65; p=0.016) were a significant risk factor for IVR in all patients and ureteral tumor location (HR, 1.35; p=0.071) was associated with IVR, although statistical significance was not achieved. In patients with renal pelvic tumor, URS-Bx HR, 1.98; p=0.020 was the only risk factor for IVR. However, URS-Bx was not associated with IVR in patients with ureteral tumor, although previous bladder tumor HR, 1.74; p=0.028 was a risk factor for IVR. Conclusion: URS-Bx is a significant risk factor for IVR in patients with renal pelvic tumor and should be performed after sufficient consideration in these patients if other examinations are uncertain.