台灣地區晚期上泌尿道上皮癌患者接受腎輸尿管切除之療效探討

王士綱¹、羅啟文^{1, 2}、游智欽^{1, 2}、蔡曜州^{1, 2}、楊緒棣^1,2

¹佛教慈濟醫療財團法人台北慈濟醫院外科部泌尿科; ²慈濟學校財團法人慈濟大學醫學院

Nephroureterectomy outcome of locally advanced and clinical node positive upper tract urothelial cancer: A Taiwan nationwide collaborative study

Shih-Gang Wang¹, Chi-Wen Lo^{1, 2}, Chih-Chin Yu^{1, 2}, Yao-Chou Tsai, M.D. PhD.^{1, 2}, Stephen Shei-Di Yang, M.D. PhD.^{1, 2}

Abstract:

Background: As for treatment of locally advanced or clinical lymph node positive upper tract urothelial carcinoma, there was a vague NCCN guideline treatment whether these patients will benefit from upfront radical nephroureterectomy (RNU) or not. Current study tried to answer the question by analyzing a high endemic area case.

Methods: Our study retrospectively reviewed locally advanced or clinical lymph node positive UTUC cohort. Once the patient’s clinical image disclosed lymph node metastasis, they will be recruited into current study. By American Joint Committee on Cancer (AJCC) staging, locally advanced UTUC was defined as tumor invading adjacent organs, or through the kidney into the perinephric fat (cT4 disease). Stage IV disease was cT4 or cN+ or cM1. We excluded the patients whose clinical image was suspected systemic metastasis. Total 292 (242 RNU and 50 without RNU) patients were enrolled in the study. The patients were further paired by propensity-score matched (PSM) with clinical T and N stage. COX regression was applied for univariable and multivariable analysis.

Results:  Before PSM, non-RNU group had more multifocal disease, smaller average tumor size, and more advanced clinical T/N stage. After 2:1 PSM, total 150 patients (100 with RNU and 50 without RNU) were analyzed. The differences of clinical T and N stage between the two groups were eliminated. In univariable analysis, non-RNU group had worse CSS than RNU group (HR 3.482, 95%CI 2.108-5.751, P-value < 0.001). Multifocal disease and tumors located in both renal pelvis and ureter could also lead to poorer CSS. However, only RNU group showed better CSS result in multivariable analysis (HR 3.040, 95%CI 1.774-5.207, P-value < 0.001).