NDP03: Bladder recurrence in patients with upper tract urothelial carcinoma after nephroureterectomy: Optimized cystoscopy follow-up strategy for early detection
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  • 2019-01-04,
  • 上傳者: TUA秘書處,
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在上泌尿道泌尿上皮癌的病人接受腎臟輸尿管切除後出現膀胱復發:可行的術後膀胱鏡追蹤策略以早期偵測腫瘤
鄭百諭、吳維哲、鍾旭東
亞東紀念醫院 外科部 泌尿科
 
Bladder recurrence in patients with upper tract urothelial carcinoma after nephroureterectomy: Optimized cystoscopy follow-up strategy for early detection
Pai-Yu Cheng, Wei-Che Wu, Shiu-Dong Chung
Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
 
Purpose: Upper tract urinary carcinoma(UTUC) accounts for 5-10% of all urothelial carcinoma(UC), but incidence up to 20-25% of UCs was reported in Taiwan. Nephroureterectomy(NU) is the standard surgical treatment for UTUC, and bladder recurrence rate is around 29%. The current guideline suggests follow up policy by cystoscopy at 3 months interval after surgery, but the evidence was not strong. Here we investigated the time span to bladder recurrence in UTUC patients, looking to optimize the better follow up strategy post surgery.
 
Materials & Methods: Between January 2007 and August 2015, 93 patients with UTUC who received nephroureterectomy in one tertiary referral hospital were retrospectively reviewed. Patients who had concurrent bladder cancer or prior TURBT for bladder cancer were excluded. Those who didn’t underwent cystoscopy before NU or missed follow-up data at months 3, 6, 9, 12, 24 were excluded. After selection, 46 patients were eligible and included in our study. (Figure 1). Chi square test and t test were used for group analysis, and Kaplan Meier was used to analysis recurrence free survival. SPSS Ver. 19 was used for statistic analysis. P values less than 0.05 were considered statistically significant.
 
Results: The demographic characteristics between the recurrence and control groups were consistent in gender, age, UTUC size, numbers, grading and T stage. Female patients are predominant in our study. All cases are margin free in the study group. In our study, 39% patients had bladder recurrence in the first two following years, and among whom, 44% patients developed bladder tumor in the first three months and total 66.7% patients had bladder recurrence in the first six months(Table 1). The Kaplan Meier recurrence free survival curve found no statistically differences between the gender, tumor size, and tumor grading. Curve diversity was observed in the T stage subanalysis, but no statistical significance was found.
 
Conclusion: Our study showed high bladder recurrence rate among UTUC patients receiving NU, especially in the first six months. We suggested more intensive cystoscopic exam in the first six months post NU for all UTUC patients, despite the tumor characteristic. Other therapy such as intravesical chemotherapy may be considered to lower the recurrence rate.
 
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    發表時間 :
    2019-01-04 16:31:41
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    240
    發表人 :
    TUA秘書處
    部門 :
    台灣泌尿科醫學會
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