台灣地區晚期上泌尿道上皮癌患者接受腎輸尿管切除之療效探討

王士綱1羅啟文1, 2、游智欽1, 2、蔡曜州1, 2、楊緒棣1,2

1佛教慈濟醫療財團法人台北慈濟醫院外科部泌尿科; 2慈濟學校財團法人慈濟大學醫學院

Nephroureterectomy outcome of locally advanced and clinical node positive upper tract urothelial cancer: A Taiwan nationwide collaborative study

Shih-Gang Wang1, Chi-Wen Lo1, 2, Chih-Chin Yu1, 2, Yao-Chou Tsai, M.D. PhD.1, 2, Stephen Shei-Di Yang, M.D. PhD.1, 2

1Division of Urology, Department of surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; 2School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.

 

Abstract:

Background: As for treatment of locally advanced or clinical lymph node positive upper tract urothelial carcinoma, there was a vague NCCN guideline treatment whether these patients will benefit from upfront radical nephroureterectomy (RNU) or not. Current study tried to answer the question by analyzing a high endemic area case.

Methods: Our study retrospectively reviewed locally advanced or clinical lymph node positive UTUC cohort. Once the patient’s clinical image disclosed lymph node metastasis, they will be recruited into current study. By American Joint Committee on Cancer (AJCC) staging, locally advanced UTUC was defined as tumor invading adjacent organs, or through the kidney into the perinephric fat (cT4 disease). Stage IV disease was cT4 or cN+ or cM1. We excluded the patients whose clinical image was suspected systemic metastasis. Total 292 (242 RNU and 50 without RNU) patients were enrolled in the study. The patients were further paired by propensity-score matched (PSM) with clinical T and N stage. COX regression was applied for univariable and multivariable analysis.

Results:  Before PSM, non-RNU group had more multifocal disease, smaller average tumor size, and more advanced clinical T/N stage. After 2:1 PSM, total 150 patients (100 with RNU and 50 without RNU) were analyzed. The differences of clinical T and N stage between the two groups were eliminated. In univariable analysis, non-RNU group had worse CSS than RNU group (HR 3.482, 95%CI 2.108-5.751, P-value < 0.001). Multifocal disease and tumors located in both renal pelvis and ureter could also lead to poorer CSS. However, only RNU group showed better CSS result in multivariable analysis (HR 3.040, 95%CI 1.774-5.207, P-value < 0.001).

Conclusions: Current study indicated the patients with locally advanced or clinical lymph node positive UTUC will benefit from upfront RNU. Therefore, we suggest locally advanced or lymph node positive but not systemic metastasis UTUC patients to receive upfront RNU in cases without contraindications for RNU.
    位置
    資料夾名稱
    摘要
    發表人
    TUA會計採購組
    單位
    台灣泌尿科醫學會
    建立
    2023-01-02 20:17:15
    最近修訂
    2023-01-02 20:24:22
    1. 1.
      Podium 01
    2. 2.
      Podium 02
    3. 3.
      Podium 03
    4. 4.
      Podium 04
    5. 5.
      Moderated Poster 01
    6. 6.
      Moderated Poster 02
    7. 7.
      Non-Discussion Poster