比較泌尿上皮癌在末期腎病變有/無接受腎臟移植及非末期腎病變患者身上的表現
鄭琮翰、詹皓程、胡哲源、楊文宏、歐建慧
國立成功大學醫學院附設醫院 泌尿部
Comparing cancer behaviors of upper tract urothelial carcinoma in patients having end-stage renal disease with or without kidney transplant and those without end-stage renal disease
Tsung-Han Cheng, Hau-Chern Jan, Che-Yuan Hu, Wen-Horng Yang, Chien-Hui Ou
Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan
Purpose: To evaluate the comparison of the behavior of upper tract urothelial carcinoma (UTUC) between non-end-stage renal disease (non-ESRD) and ESRD with and without kidney transplant (KT).
Materials and Methods: We reviewed 479 patients with UTUC treated with radical nephroureterectomy (RNU) between January 2005 and December 2017. Patients are divided into four groups according to preoperative renal function and whether KT is performed (non-ESRD, eGFR ≧ 60 ml/min/1.73 m² and non-ESRD, eGFR < 60 ml/min/1.73 m², and ESRD with KT and ESRD without KT). Kaplan-Meier survival plot and multivariate analysis were used to determine whether pre-operative renal function and whether kidney transplant would influence UTUC outcome.
Results: Of the 479 patients, 183 (38%) were non-ESRD with eGFR ≧ 60 ml/min/1.73 m², 192 (40%) non-ESRD with eGFR < 60 ml/min/1.73 m², 78 (16%) ESRD without KT, and 26(6%) with KT. Kaplan-Meier curve analysis showed ESRD with KT group tends to have higher metachronous contralateral UTUC than the other three groups(p < 0.05). ESRD patients (with or without KT) had higher bladder cancer recurrence than the non-ESRD group (p < 0.05). There was no significant difference in local or distant metastasis, cancer-specific death or overall survival within four groups.
Conclusions: KT significantly had a higher risk of contralateral UTUC. ESRD group (KT and non-KT) had higher intravesical recurrence compared to CKD non-ESRD group in UTUC patients treated with NUR. We should provide more careful follow-up and postoperative intravesical therapy for ESRD patients with or without KT.