對側再發上尿路尿路上皮癌手術後之療效分析：多中心登錄研究

李彥良¹、高耀臨¹、陳逸軒²、余家政²、張兆祥³^,⁴、吳錫金³^,⁴^,⁵、李經家⁶^,⁷^,⁸^,⁹、吳文正⁷^,⁸^,⁹、蔡曜州¹⁰^,¹¹^,¹²、游智欽¹¹^,¹²、蔡宗佑¹³^,¹⁴、鄭百諭⁷^,⁸^,⁹、黃昭淵¹⁵、歐建慧¹⁶

¹國立成功大學醫學院附設醫院 泌尿科；²高雄榮民總醫院 外科 泌尿科；³中國醫藥大學附設醫院 泌尿科；⁴中國醫藥大學 醫學院；⁵中國醫藥大學 北港附設醫院 泌尿科；⁶高雄醫學大學 岡山附設醫院 泌尿科；⁷高雄醫學大學附設醫院 泌尿科；⁸高雄醫學大學 醫學院 泌尿科；⁹高雄醫學大學 臨床醫學研究所；¹⁰台北慈濟醫院 外科；¹¹佛教慈濟大學 醫學院；¹²台北醫學大學附設醫院 泌尿科；¹³遠東紀念醫院 外科 泌尿科；¹⁴元智大學 電機工程學系；¹⁵台大醫院 泌尿科；¹⁶衛生福利部台南醫院 泌尿科

Oncologic outcomes following surgical management of contralateral recurrent upper tract urothelial carcinoma: Evidence from a multicenter registry

Yen-Liang Li¹, Yao-Lin Kao¹, I-Hsuan Alan Chen², Chia-Cheng Yu², Chao-Hsiang Chang³^,⁴, Hsi-Chin Wu³^,⁴^,⁵, Ching-Chia Li⁶^,⁷^,⁸^,⁹, Wen-Jeng Wu⁷^,⁸^,⁹, Yao-Chou Tsai¹⁰^,¹¹^,¹², Chih-Chin Yu¹¹^,¹², Chung-You Tsai¹³^,¹⁴, Pai-Yu Cheng¹³^,¹⁴, Chao-Yuan Huang¹⁵, Chien-Hui Ou¹⁶

¹ Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; ² Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan;³ Department of Urology, China Medical University and Hospital, Taichung, Taiwan; ⁴ School of Medicine, China Medical University, Taichung, Taiwan; ⁵ Department of Urology, China Medical University Beigang Hospital, Yunlin, Taiwan; ⁶ Department of Urology, Kaohsiung Medical University Gangshan Hospital, Kaohsiung, Taiwan; ⁷ Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; ⁸ Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; ⁹ Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; ¹⁰ Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; ¹¹ School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan; ¹² Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan; ¹³ Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; ¹⁴ Department of Electrical Engineering, Yuan-Ze University, Taoyuan, Taiwan; ¹⁵ Department of Urology, National Taiwan University Hospital, Taipei, Taiwan; ¹⁶ Department of Urology, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan

Purpose:

Although contralateral recurrence of upper tract urothelial carcinoma (UTUC) after curative surgery is rare, it presents a meaningful clinical challenge with no clear surgical standard. This study compared the oncological outcomes of alternative surgical approaches among patients who experienced contralateral recurrence after undergoing nephroureterectomy (NUR).

Materials and Methods:

We used data from the Taiwanese UTUC Registry (2018–2024) to identify patients who received curative-intent surgery for unilateral UTUC or for contralateral recurrence. These patients were stratified into three surgical cohorts: (1) primary unilateral UTUC treated with NUR; (2) contralateral recurrence treated with repeat NUR; and (3) contralateral recurrence treated with nephron-sparing surgery (NSS), such as segmental ureterectomy or endoscopic ablation. The primary outcomes assessed were overall survival (OS), cancer-specific survival (CSS), and bladder recurrence-free survival (BRFS). Propensity score–based weighting was used to adjust for differences in baseline clinical and pathological features among the groups.

Results:

Adjusted analyses showed no meaningful differences in OS, CSS, or BRFS among the three groups. Procedure type and laterality were not independent predictors, whereas tumor stage and lymphovascular invasion were the key determinants of prognosis. Similar findings were observed across subgroups despite the small number of contralateral recurrences.

Conclusion:

In this multicenter real-world study, both repeat NUR and selected NSS yielded oncological outcomes equivalent to primary surgery, underscoring the practicality of curative-intent surgical management for contralateral recurrence. Larger-scale studies are needed to corroborate these findings.