先導性研究比較放射線治療與腎臟輸尿管全切除於上泌尿道泌尿上皮癌之療效
陳浩瑋1,2、湯人仰3、陳妤甄1,2、李經家1、葉信志4、闕光瞬4、李香瑩4、蔡嘉駿4、吳文正2,4
1高雄醫學大學附設醫院泌尿部；2高雄醫學大學臨床醫學研究所；3高雄市立大同醫院放射腫瘤科；4高雄市立大同醫院泌尿科
Primary Radiotherapy for Upper Tract Urothelial Carcinoma: A Pilot Study
Hao-Wei Chen1,2, Jen-Yang Tang3, Yu-Chen Chen1,2, Ching-Chia Li1, Hsin-Chih Yeh4, Kuang-Shun Chueh4, Hsiang-Ying Lee4, Chia-Chun Tsai4, Wen-Jeng Wu2,4
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan1;
Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan2;
Division of radiation oncology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan3
Divisions of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan4
Purpose:
To perform a pilot study to compare the outcomes and complications of primary radiotherapy and radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC) and multiple comorbidities.
Materials and Methods:
Between January 2011 and December 2016, patients with UTUC with Charlson comorbidity index ≥3 who received treatments at our tertiary medical center were included. Two treatments were performed: 1) primary radiotherapy and 2) RNU. All patients were pair-matched using propensity scores according to their clinical characteristics. Outcomes including relapse-free, cancer-specific, and overall survival were analyzed using the Cox regression model. Complications were compared in the two treatments by using Fisher’s exact test.
Results:
After propensity score matching (3:1 ratio), 48 patients in the RNU group and 16 patients in the primary radiotherapy group were enrolled in this study. There were no significant differences in the relapse-free (hazard ratio [HR]: 0.38, 95% confidence interval [CI]: 0.04–3.58), cancer-specific (HR: 0.24, 95% CI: 0.03–2.03), and overall (HR: 0.34, 95% CI: 0.07–1.61) survival between the primary radiotherapy and RNU groups. However, we noted significantly increased grade >1 complications in patients who underwent RNU (p = 0.027).
Conclusion:
Modest complications and fair outcomes indicated the potential benefit of applying primary radiotherapy in patients with UTUC and multiple comorbidities. In the future, randomized control trials will be performed based on the findings of this pilot study.