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 Yang2,3, 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.