末期腎病病患罹患上泌尿道泌尿上皮癌接受腎臟輸尿管切除手術之分析：

單一中心經驗

蔡仕傑¹、黃逸修^1,2、黃子豪^1,2、魏子鈞^1,2、林志杰^1,2、

林子平^1,2、鍾孝仁^1,2、張延驊^1,2、黃志賢^{1, 2}

¹臺北榮民總醫院泌尿部；²國立陽明交通大學醫學系泌尿學科及書田泌尿科學研究中心

The Characteristics of End Stage Renal Disease Patients with Upper Urinary Tract Urothelial Cancer Treated with Radical Nephroureterectomy: A Single Center Experience

Shi-Jie Tsai¹, Eric Yi-Hsiu Huang ^{1, 2}, Tzu-Hao Huang^{1, 2}, Tzu-Chun Wei^{1, 2}, Chih-Chieh Lin^{1, 2},

Tzu-Ping Lin^{1, 2}, Hsiao-Jen Chung^{1, 2}, Yen-Hwa Chang^{1, 2}, William J.S. Huang^{1, 2}

¹ Department of Urology, Taipei Veterans General Hospital,

²Department of Urology, College of Medicine and Shu-Tien Urological Science Research Center,

National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose:

Radical nephroureterectomy (RNU) is the current standard treatment of upper tract urothelial carcinoma (UTUC). In Taiwan, it is well known that end stage renal disease (ESRD) patients receiving dialysis are associated with increased risk of urothelial carcinoma, especially remarkably high incidence of UTUC. It would be interesting to investigate UTUC patients with prolonged history of dialysis treated with RNU regarding the disease characteristics, surgical and oncological outcomes. Herein, we presented our single center experiences.

Materials and Methods:

We did a retrospectively review for ESRD patients received RNU due to UTUC at Taipei Veterans General Hospital from 2005 to 2019. The demographic data, histopathological features, perioperative complications, and oncologic outcomes were analyzed. A comparison was also made for patients with and without ESRD underwent dialysis using Chi-square and Kaplan-Meier methods.

Results:

In total, 54 ESRD patients were identified with UTUC. The average age at RNU of dialysis patients was 65.5±14.5 years (range 22-89). For the 54 ESRD patients, 42 (78%) received unilateral RNU, 2 (4%) received bilateral RNU, and 10 (18%) received complete urinary tract exenteration (bilateral RNU with radical cystectomy). The methods of surgical approach were open in 25 (46%) cases, laparoscopy in 22 (41%) cases, and robotic-assisted in 7 (13%) cases. The time interval from initiation of dialysis to RNU was 5.3±4.6 years (range 0.2-15). The perioperative complication rate was 26%, and only 2% were major complications (≥ grade III Clavien-Dindo classification).

The histopathological results of RNU showed 16 (29%) patients with locally advanced stage (pT3/4 or node positive) tumors. Presence of concomitant carcinoma in situ (CIS) was identified in 8 (14%) patients. Furthermore, high incidence of multifocal tumors was found in 20 (36%) dialysis patients.

The median follow-up period of our cohort was 51 months (range 5-176). The overall survival was 68%, and cancer-specific survival was 83%. For dialysis patients with urinary bladder preserved after RNU, bladder recurrences were noted in 10 (23%) patients, with a median interval of 11 months from RNU to recurrence. The comparisons between dialysis and non-dialysis patients has yet to be reported.

Conclusions:

UTUC in ESRD patients have high incidence of multifocal tumors. Our experiences showed low complication rates and good long-term survival of these patients treated by RNU.