上泌尿道癌症洗腎患者接受腎臟輸尿管切除手術後的長期預後
戴大堯、歐建慧
國立成功大學附設醫院 泌尿部
Long-term outcome of nephrouretrectomy in dialysis patients with upper tract urothelial carcinoma
Ta-Yao Tai, Chien-Hui Ou
Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan
Background
Nephroureterectomy and bladder cuff resection is a standard surgical management for patients with upper tract urothelial carcinoma (UTUC). However, the long-term survival outcomes in dialysis patients is insufficient throughout literature.
The present study is the first large cohort study to discuss the outcomes of dialysis patients with upper tract urothelial cell carcinoma (UTUC) who received nephroureterectomy, with a long-term follow-up. These outcomes provide further evidence suggesting that nephroureterectomy with bladder cuff resection is a feasible strategy and providing effective oncological control of dialysis patients with UTUC in an experienced center.
Objective
To report the long-term outcomes of dialysis patients with upper tract urothelial cell carcinoma (UTUC) who received nephroureterectomy at a single institution over a 10-year period.
Patients and methods
Patients who underwent nephroureterectomy between November 2003 and November 2013 were identified from National Cheng Kung University Hospital (NCKUH), a tertiary medical center in Taiwan. Outcomes were obtained via retrospective analysis of notes and electronic records. Overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS) were estimated using Kaplan–Meier methods and grade-stratified differences were analyzed using the log-rank test.
Results
Between November 2003 and November 2013, 270 patients underwent nephroureterectomy of UTUC with a median age at diagnosis of 68 years. Median (range; mean) follow-up was 29 (2–120; 35.3) months. In total, 23.3% (n = 63) of the patients underwent dialysis. In general, dialysis patients were younger, and had better pathological stage, tumor grade and lymphovascular invasion. The estimated OS in non-dialysis group and dialysis group were 70% and 84%, respectively, at 5 years, and 57% and 60%, respectively, at 10 years (p=0.2187). The estimated mean RFS in non-dialysis patients and dialysis patients was 67.6% and 68.3%, respectively at 5 years.
Conclusion
In this present single center cohort study, nephroureterectomy in dialysis patients with UTUC was feasible and could provide effective oncological control.