上泌尿道尿路上皮癌手術後對側復發之危險因子
吳英龍1、黃逸修1,2、林登龍1,2、張延驊1,2、鍾孝仁1,2、盧星華1,2、林子平1,2、林志杰1,2、范玉華1,2、黃奕燊1,2、魏子鈞1、黃子豪1、顧明軒1、黃志賢1,2
臺北榮民總醫院 泌尿部1
國立陽明交通大學醫學院泌尿學科及書田泌尿科學研究中心2
Risk Factors of Contralateral Recurrence of Upper Tract Urothelial Carcinoma Following Radical Nephroureterectomy
Ying-Long Wu1, Eric Yi-Hsiu Huang1,2, Alex T.L. Lin1,2, Yen-Hwa Chang1,2, Hsiao-Jen Chung1,2,
Shing-Hwa Lu, 1,2 Tzu-Ping Lin1,2, Chih-Chieh Lin1,2, Yu-Hua Fan1,2, I-Shen Huang1,2, Tzu-Chun Wei1,2,
Tzu-Hao Huang1,2, Ming-Hsuan Ku1,2, William J.S. Huang1,2
1Department of Urology, Taipei Veterans General Hospital
2Department of Urology, College of Medicine and Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
Purpose: The occurrence of contralateral upper tract urothelial carcinoma (UTUC) following unilateral radical nephroureterectomy (RNU) is extremely rare. We aim to identify the risk factors of contralateral UTUC recurrence in patients who had prior RNU.
Materials and Methods: A retrospective review was conducted in UTUC patients who underwent nephroureterectomy from 2010~2020 in our hospital. Contralateral recurrence was confirmed by images and biopsy. The risk factors including patient, peri-operative, and tumor factors were analyzed with Cox proportional hazard model.
Results: In total, 605 patients were enrolled with 305 males and 300 females. 23 patients (3.8%) who had contralateral recurrence at a mean follow-up period of 94.9 months. The mean age of the patients with contralateral recurrence was 63.8±17.1 years. The mean recurrence free time of contralateral occurrence following unilateral RNU was 50.2 months (range 2~200 months; median 36 moths, IQR 76 months). In univariate analyses, age (HR 0.96, p=0.011), previous history of bladder cancer (HR= 4.64, p=0.001) and dialysis before operation (HR=3.644, p=0.012) possess higher risk with recurrence, but did not show statistical difference in multivariate analyses. Females tend to have 2 fold risk than male in contralateral recurrence, although showed no statistical significance (HR= 2.14, p= 0.096).
Conclusions: The incidence of contralateral recurrence of UTUC following unilateral RNU was 3.8% with a mean recurrence free survival of 50.2 months. Age, previous history of bladder cancer, and dialysis patients were more prone to have contralateral recurrence in univariate analysis.