Significance of the timing of ureteral ligation on prognosis during radical nephroureterectomy for upper urinary tract urothelial cancer
Significance of the timing of ureteral ligation on prognosis during radical nephroureterectomy for upper urinary tract urothelial cancer
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DOI：
10.1111/iju.14435
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发表时间：
2020-11-29
影响因子：
2.6
通讯作者：
Naito, Seiji
中科院分区：
文献类型：
--
作者：
Inokuchi, Junichi;Kuroiwa, Kentaro;Naito, Seiji
目的探讨上尿路尿路上皮癌根治性肾输尿管切除术中输尿管结扎时机对膀胱内复发及预后的影响。我们排除了既往和/或同时患有膀胱癌、临床淋巴结阳性、无输尿管结扎数据、未进行输尿管结扎和数据缺失的患者。我们调查了肾血管结扎前输尿管结扎（早期输尿管结扎）或肾血管结扎后输尿管结扎（晚期输尿管结扎）患者膀胱内复发和癌症特异性死亡率的累积发生率，以及总生存率。随访期间（中位3.9年），218例患者（32.8%）发生膀胱内复发。早期和晚期输尿管结扎组膀胱内复发率无显著差异。同时，早期输尿管结扎组的生存率明显低于晚期输尿管结扎组。多变量分析显示早期输尿管结扎是总生存期的独立预后因素（风险比1.88，95%置信区间1.24-2.85，P = 0.003）和癌症特异性死亡率（风险比1.93，95%置信区间1.14-3.25，结论根治性肾输尿管切除术中输尿管结扎时机对膀胱内复发率无明显影响。然而，早期输尿管结扎可能对生存结果有负面影响。
Objectives To investigate the impact on intravesical recurrence and prognosis according to the ureteral ligation timing during radical nephroureterectomy for upper urinary tract urothelial carcinoma.Methods We carried out a retrospective chart review of 664 patients with non-metastatic upper urinary tract urothelial carcinoma who underwent radical nephroureterectomy with ureteral ligation (supplementary analysis of JCOG1110A). We excluded patients with previous and/or synchronous bladder cancer, clinically node-positive disease, no ureteral ligation data, those without ureteral ligation and those with any missing data. We investigated the cumulative incidence of intravesical recurrence and cancer-specific mortality, and overall survival between patients with ureteral ligation before renovascular ligation (early ureteral ligation), or ureteral ligation after renovascular ligation (late ureteral ligation).Results Early and late ureteral ligation was carried out in 243 patients (36.6%) and 421 patients (63.4%), respectively. Intravesical recurrence occurred in 218 patients (32.8%) during follow up (median 3.9 years). No significant difference in the intravesical recurrence was found between early and late ureteral ligation groups. Meanwhile, survival in the early ureteral ligation group was significantly worse compared with the late ureteral ligation group. Multivariable analysis showed that early ureteral ligation was an independent prognostic factor for overall survival (hazard ratio 1.88, 95% confidence interval 1.24-2.85, P = 0.003) and cancer-specific mortality (hazard ratio 1.93, 95% confidence interval 1.14-3.25, P = 0.014).Conclusions Our findings suggest that the incidence of intravesical recurrence is not affected by the timing of ureteral ligation during radical nephroureterectomy. However, early ureteral ligation might have a negative impact on survival outcomes.