上泌尿道尿路上皮癌腫瘤位置對根除性腎臟全切除術後膀胱內復發之影響
鐘伯恩1、羅啟文1,2、游智欽1,2、蔡曜州1,2
佛教慈濟醫療財團法人台北慈濟醫院 泌尿科; 慈濟大學 醫學系
The impact of tumor location on intravesical recurrence in patients with upper tract urothelial carcinoma after radical nephroureterectomy
Bor-En Jong1, Chi‐Wen Lo1,2, Chih-Chin Yu1,2, Yao-Chou Tsai1,2
Division of Urology, Taipei Tzu Chi Hospital, Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
Purpose:
The intravesical recurrence (IVR) is one of the common discussions for the treatment of upper urinary tract urothelial carcinoma (UTUC). However, the relationship between risk of IVR and separated tumor location on ureter/ renal pelvis were inconclusive. We conducted a retrospective multi-institution study to answer this question.
Materials and Methods:
From the data of Taiwan UTUC Collaboration Group, there were 4160 patients identified. We only enrolled patients received radical nephroureterectomy (RNU) with tumor purely located in single anatomical position. Those with multifocality, CIS, history of prior/concomitant bladder urothelial carcinoma, prior UTUC received renal sparing surgery or contralateral UTUC were excluded. Student’s t test was adapted for continuous variables. The Pearson’s Chi-square test was adapted for categorical variables. The univariate analysis was performed with logistic regression. Potential confounders that significantly confound the correlation between variables and outcomes were adjusted with logistic regression models.
Results:
From 2008 to 2018, there were 766 patients enrolled in our study. The location of tumor was not related to the risk of IVR. Female gender has less risk of IVR (OR: 0.517, 95% CI: 0.340~ 0.772, p< 0.001). Patient with low grade tumor has higher risk of IVR (OR: 1.288, 95% CI: 1.032~ 1.609, p= 0.025) and adjuvant chemotherapy was the only relieve factor of IVR (OR: 0.493, 95% CI: 0.275~ 0.883, p= 0.017).
Conclusion:
Tumor location was not the risk factor of IVR. Female and adjuvant chemotherapy were the protective factor of IVR after RNU. The relationship between tumor grade and IVR needs further study confirm the result.