上泌尿道上皮癌患者接受全腎臟輸尿管切除手術後脾臟體積變化與癌症預後之關聯性分析

羅建雄、詹皓程、胡哲源、楊文宏、歐建慧

國立成功大學醫學院附設醫院 泌尿部

Postoperatively increased splenic volume correlates with an unfavorable prognosis in patients after radical nephroureterectomy to treat upper tract urothelial carcinoma

Chien-Hsiung Lo^1,Ϯ , Hau-Chern Jan^{1,2,3, Ϯ}, Che-Yuan Hu^1,2, Wen-Horng Yang^1,2, Chien-Hui Ou^1,4,*

¹ Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

² Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

³ Division of Urology, Department of Surgery, National Cheng Kung University Hospital Dou-Liou Branch, Yunlin, Taiwan.

⁴ Department of Urology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Purpose

To evaluate the impact of splenic volume (SV) change on prognosis in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).

Patients and Methods

From 2009 to 2020, our study collected 300 non-metastatic UTUC patients undergoing RNU who had received abdominal computer tomography (CT) within 3 months before RNU and within 24 months after RNU. SV on CT image was estimated using cross sectional area summed method. The optimal cut-off point of SV change between pre-and post-surgery was determined by receiver operating characteristic (ROC) analysis based on cancer-related death. Subsequently, Kaplan–Meier analyses were performed to assess the association of SV change with overall survival (OS) and cancer-specific survival (CSS); Cox regression analyses was conducted to evaluate independent factors for predicting OS and CSS.

Results

In the retrospective cohort study of 300 patients, 80 patients (27%) had increased SV by 10% within 24 months after RNU, who had shorter OS and CSS, compared to the remaining without increased SV by 10%, in Kaplan–Meier analysis. An increase in SV by 10% was an independent factor for predicting a worse OS (HR=1.961, 95% CI 1.268-3.033; P = 0.002) and CSS (HR=2.152, 95% CI 1.35-3.430; P = 0.001) in multivariate Cox regression analysis.

Conclusion

The SV change of patients in two years after RNU to treat UTUC was significantly associated with mortality. An increase in SV by 10% within two years after surgery was demonstrated as an independent prognosticator for an unfavorable outcome.

Keyword Splenic volume, SV, outcome, prognosis, UTUC