上泌尿道泌尿上皮細胞癌內視鏡雷射燒灼手術後真實世界結果

黃國倫¹、吳俊賢¹、林嘉祥^1、2

¹義大醫療財團法人義大醫院 泌尿科；

²義守大學 醫學系

Real-world outcome of endoscopic laser ablation for upper urinary tract urothelial carcinoma

Allen, Guo-Lun Haung¹, Chun-Hsien Wu¹, Victor C. Lin^1,2

Department of Urology¹, E-Da Hospital, Kaohsiung, Taiwan;

School of Medicine, College of Medicine², I-Shou University, Kaohsiung, Taiwan

Purpose: Radical nephroureterectomy (RNU) is the gold standard treatment for upper urinary tract urothelial carcinoma (UTUC). For patients with low-grade and low-volume UTUC, endoscopic laser ablation is an option recommended by the National Comprehensive Cancer Network guidelines. In the real world, patients with renal function impairment, a solitary kidney, or contraindications to RNU will consider endoscopic laser ablation for high-grade UTUC. The study aims to evaluate the real-world durability and safety of endoscopic laser ablation for patients with UTUC.

Materials and Methods: This study enrolled nineteen patients with UTUC irrespective of cancer grading who received endoscopic laser ablation in a single center from 2016 to 2023. Primary outcome was recurrence of UTUC which was determined by ureteroscopy, computed tomography, magnetic resonance imaging or final pathology of RNU. Recurrence-free survival (RFS) was estimated by Kaplan-Meier survival analysis. Secondary outcomes were post-operative complications, distant metastasis and numbers of receiving RNU after endoscopic laser ablation.

Results: The median age was 72 years old (range 53-91). Nine patients (47.3%) had a solitary kidney. Mean pre-operative estimated glomerular filtration rate was 38.26 mL/min. Eleven patients (57.8%) had a previous history of UTUC. Seventeen patients (89.4%) was diagnosed as high-grade urothelial carcinoma. The distributions of UTUC were 5 (26.3%) in ureter alone, 8 (42.1%) in renal pelvis alone, and 6 (31.5%) in concurrent renal pelvis and ureter. Mean tumor size was 19.6 ± 10.27 mm. Median time of follow up was 19 months (range 3-66 months). RFS was 15% at 12 months by Kaplan-Meier analysis. Ureteric stenosis was the most frequently reported complications (5/19, 26.3%), followed by urinary tract infection / acute pyelonephritis (4/19, 21.0%) during follow-up. One (5.2%) patient developed lung metastasis. Only two patients (10.5%) proceeded to end stage renal disease. Four (21.0%) patients received RNU.

Conclusions: Considering the low incidence of distant metastasis and renal function deterioration in our patients, endoscopic laser ablation could be the minimally invasive treatment for UTUC. In view of short RFS of UTUC, strict follow-up is necessary.