內視鏡腎臟保留手術以不傷害癌症預後之前提下保留腎臟功能:以治療權重倒數機率分析泌尿道上皮癌
沈志宇1、蔡育賢1、詹皓程1、歐建慧1、楊文宏1、蔡宗欣2
1成功大學醫學院附設醫院泌尿部;2中國醫藥大學安南醫院泌尿部
Kidney sparing surgery preserves renal function without compromising oncological outcome: An inverse probability of treatment weighting analysis in upper tract urothelial carcinoma
Chih-Yu Shen1, Yuh-Shyan Tsai1, Jan Hau-Chern1Chien Hui Ou1, Wen Horng Yang1, Tzong-Shin Tsai2
1Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2Department of Urology, An-Nan Hospital; Department of Urology, School of Medicine, China Medical University, Taichung, Taiwan
 
Purpose: This study compares long-term outcomes between radical nephroureterectomy(RNU) and kidney-sparing surgery (KSS) to upper tract urothelial carcinoma, using inverse probability of treatment weighting (IPTW) based on propensity scores to control for selection bias.
Materials and Methods: Patients undergoing radical nephroureterectomy and kidney-sparing surgery for Ta/T1 upper tract urothelial carcinoma from 2004 to 2018 were analysed. Inverse probability of treatment weighting (IPTW) based on propensity scores were generated in an effort to adjust for potential bias due to non-randomization and used to assess the marginal treatment effect of the kidney sparing surgery via a weighted Cox proportional hazards model. Oncologic outcomes including overall survival, progression free survival, and renal function assessed 12 months after treatment were evaluated.
Results: A total of 184 patients with cTa/T1 UTUC were initially included and those with end stage renal disease (ESRD) or without previous ureteroscopic biopsy were excluded from the study. Finally a total of 65 patients were enrolled for analysis, of which, 23 received KSS and 42 received RNU. After IPTW, the population was well balanced. With a median follow up of 43.60 months, weighted Kaplan-Meier survival analysis showed no difference in 5-year overall survival (OS) (94.48 % vs 94.57%, p=0.55) and recurrence-free survival (RFS) (58.60 % vs 61.81%, p=0.89) between KSS cohort and RNU cohort. The estimated glomerular filtration rate (eGFR) decreased 20.2% and 0.0% one year after the operation in the RNU cohort and KSS cohort respectively (p<0.001). Linear regression demonstrated that operation type (p=0.011) and gender (p=0.002) was significantly associated with eGFR changes 12 months after operation in multivariable model. The renal salvage rate was 60.86% and 5 year RNU-free survival was 64.6% in our study.
Conclusion: In our experience, after accounting for bias in treatment assignment, endoscopic management of urothelial carcinoma provides equivalent oncologic outcomes in regards of OS and PFS when compared with RNU. The benefit of renal function preservation was also demonstrated in our study. It is therefore, a reasonable approach to treat selected patients with a meticulous and stringent postoperative follow up schedule.
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    TUA人資客服組
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    台灣泌尿科醫學會
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    2020-06-09 17:21:38
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    2020-06-09 17:22:11
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