台灣地區上泌尿道上皮癌之腎元保留手術預後及危險因子分析

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

Segmentectomy outcome of upper tract urothelial cancer in a high endemic area: 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}

¹Division of Urology, Department of surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; ² School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.

Abstract:

Background: According to NCCN guideline, ureterectomy of upper tract urothelial cancer (UTUC) is a considerable option for selected mid and distal ureteral UC. As a UTUC endemic area, Taiwan lack of treatment outcome analysis of segmentectomy.

Methods: Current study retrospectively reviewed the treatment outcomes of ureterectomy for clinically localized UTUC. Patients with biopsy or washing cytology confirmed UTUC who underwent open, laparoscopic or robotic-assisted management with a curative intent were retrospectively reviewed for eligibility of analysis. COX regression was applied for univariable and multivariable analysis.

Results: Total 161 patients underwent ureterectomy were reviewed and eligible for final analysis. Median follow-up period was 44.5 months (inter-quartile range (IQR): 21.6-84.9 months).

After segmentectomy, 56/161 (34.8%) cases were free of UTUC at the end of follow-up. As for recurrence, 25/161 (15.5%) patients had local recurrence and 35/161 (21.7%) patients got lymph node or distant metastasis. Pathological T2 stage or more tended to have higher local recurrence rate and metastasis rate. Higher bladder recurrence and local recurrence rate were observed if concurrent bladder UC presented. For management of local recurrence, 19 patients received salvage RNU and 25 patients had adjuvant chemotherapy. 26/161 (16.1%) patients died of UTUC and 3/161 (1.9%) patients had surgical related mortality. Advanced stage more than T2, lymphovascular invasion and surgical margin involvement were the risk factors associated with worse cancer specific survival (CSS).

Conclusions: By carefully selecting patients, ureterectomy of clinical localized UTUC could be performed safely and efficiently. The surgical intervention was not recommended if the patient’s tumor was T2 stage or more. Further, concurrent bladder UC was also a red flag for bladder recurrence and local recurrence. Advanced stage more than T2, lymphovascular invasion and surgical margin involvement were risk factors for worse CSS.