台灣上泌尿道泌尿上皮癌經內視鏡手術後之長期觀察—台灣上泌尿道泌尿上皮癌資料庫回溯分析

林敬哲、戴定恩、周安琪、吳致寬、蔡曜州

台北醫學大學附設醫院泌尿科

Long term outcomes of endoscopic management of upper urinary tract urethelial carcinoma(UTUC) in Taiwan UTUC registry

Ching-Che Lin¹, Ting-En Tai, An-Chi Chou, Chih-Kuan Wu, Yao-chou Tsai^1,2

¹Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan

²Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

Purpose:  

The aim of this study was to analyze outcomes of endoscopic management of upper urinary tract urethelial carcinoma in Taiwan.

Materials and Methods:

A total of 179 patients underwent endoscopic management of upper urinary tract urethelial carcinoma including flexible ureteroscopic, semirigid ureteroscopic, percutaneous nephroscopic, flexible ureteroscopic combined with percutaneous nephroscopic treatment.

Pre-operative characterisitics, post- operative overall survival, disease-free survival, cause specific survival, bladder recurrence free survival were analyzed.

Results:

According to our database(Taiwan UTUC registry), mean age 70.62±11.69, with male patients accounts for 43%(77 patients) while female acconts for 57%(102 patients). Initial tumor clinical staging were cTx(N=87, 48.6%), cTis(N=1, 0.6%), cTa(N=32, 17.9%), cT1(N=32, 17.9%), cT2(N=21, 11.7%), cT3(N=4, 2.2%), cT4(N=1, 0.6%). Enscopic treatment were performed by flexible ureteroscopic(N=118,65.9%),semirigid ureteroscopic(N=43, 24%), percutaneous nephroscopic(N=3, 1.7%),  flexible ureteroscopic combined with percutaneous nephroscopic treatment(N=1, 0.6%). Mean follow-up was 41.18±35.75 months. We found significant lower 5-year overall survival rate(OS) in clinical lymph node(cN stage) positive patients(p=0.003, HR=29.01) and initial ureteroscopic higher Tumor stage(cT stage, cT1-2, p=0.002, HR:5.35). Besides, we also found significant lower disease-free survival (DFS) in clinical lymph node(cN stage) positive patients(p=0.002, HR=38.77), initial ureteroscopic higher Tumor stage(cT stage, cT1-2, p=0.001, HR:11.92), patients underwent chemotherapy(p=0.006, HR=4.34) and patients who underwent radiation therapy(p=0.02, HR:4.34).

The 5-year overall survival rate(OS) was significant higher in tumor size(<1cm) group(p=0.02), and cause specific survival ratre as well(P=0.032). We found significant higher 5-year disease-free survival(DFS) in renal pelvis tumor group(p=0.005) and lower ureter tumor group(P=0.023). However, bladder recurrence free survival was significant lower in bladder cuff tumor group(P=0.001).   

Conclusions:

The role of endoscopic treatment for UTUC continues evolving these years. According to this retrospective data in UTUC Taiwan Registry, we found higher OS in tumor size < 1cm patients, and higher DFS in renal pelvis and lower ureter tumor. Lower DFS in clinical positive lymph node metastasis and higher T stage patients. But there were no significant findings in OS.