腎輸尿管切除手術對原發性IV 期（非轉移性和轉移性）

上泌尿道泌尿上皮癌患者存活的影響

林威宇¹、林孟宏²、楊曜旭^2,3、陳文政⁴、黃慈恩⁵、陳妙芬⁴、吳俊德⁶

嘉義長庚紀念醫院 ¹外科部泌尿科，²健康加值中心，³中醫部，⁴放射腫瘤科，⁵血液腫瘤科;

⁶基隆長庚紀念醫院 外科部 泌尿科

Survival Impact of Nephroureterectomy for De Novo Stage IV

(Nonmetastatic and Metastatic) Upper Tract Urothelial Carcinoma

Wei-Yu Lin¹, Meng-Hung Lin², Yao-Hsu Yang^2,3, Wen-Cheng Chen⁴, Cih-En Huang⁵, Miao-Fen Chen⁴, Chun-Te Wu⁶

¹Division of Urology, Department of Surgery, ²Health Information and Epidemiology Laboratory,

³Department of Traditional Chinese Medicine, ⁴Department of Radiation Oncology and ⁵Division of

Hematology Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan;

⁶Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

Purpose: The beneficial role of nephroureterectomy (NU) in stage IV upper tract urothelial carcinoma (UTUC) is unclear. We investigated the impact of chemotherapy (CT) alone compared with CT plus NU in overall survival (OS) among patients with stage IV nonmetastatic UTUC (nmUTUC) and

metastatic UTUC (mUTUC).

Materials and Methods : A multicenter retrospective cohort study with UTUC patients was conducted from the Chang Gung Cancer Database (2002–2015) and followed up until August 2017. The patients were categorized as CT alone and CT+NU. OS and hazard ratios (HRs) were assessed by Kaplan–Meier

method and Cox proportional hazards model, respectively.

Results: This study included 308 patients with stage IV UTUC, comprising those with nmUTUC (n = 139) and mUTUC (n = 169); of them, 122 (39.6%) received NU. Specifically, 91 (74.6%) with nmUTUC and 31 (25.4%) with mUTUC received NU. Patients who received CT+NU exhibited higher 3-year OS (16.7% vs 41.0%, p < 0.001), longer median OS duration (20.7 vs 9.0 months, p < 0.001), and lower HR of death (HR, 0.48; 95% confidence interval [CI], 0.36–0.66; p < 0.001) compared with those who received CT alone. Similarly, longer median OS duration (25.0 vs 7.8 months, p < 0.001) and lower HR of death (HR, 0.37; 95% CI, 0.23–0.59; p < 0.001) were found in patients with mUTUC who underwent

CT+NU than in those who received CT alone.

Conclusions: Compared with CT alone, NU plus CT can provide benefits in 3-year OS to patients with

nonmetastatic and metastatic stage IV UTUC.