採PLUCK方式內視鏡腎輸尿管切除手術之上尿路泌尿上皮細胞癌腫瘤相關預後
曾仁澍1、陳建志1,2,3、張奐光1、許炯明1,2,3楊志東1、蔡維恭1,2
、林文州1、江百凱1,2、周永強1,2、林文榮1,2、邱文祥1,2,4
1台北馬偕紀念醫院 泌尿科、2馬偕醫學大學醫學院、3馬偕醫護管理專科學校、4陽明大學醫學院
The Oncological Outcomes after Pluck Method Laparoscopic Nephroureterectomy for Upper Tract Urothelial Carcinoma
Jen-Shu Tseng1, Chih-Chiao Lee1, Ting-Po Lin1, Marcelo Chen1,2,3, Huang-Kuang Chang1,
Jong-Ming Hsu 1,2,3, Stone Yang1, Wei-Kung Tsai1, Wen-Chou Lin1, Pai-Kai Chiang1, Yung-Chiong Chow1,2, Wun-Rong Lin1, Prof. Allen W. Chiu,1,2,4
1Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
2 Mackay Medical College, New Taipei City, Taiwan
3Mackay junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
4School of Medicine, National Yang-Ming University, Taipei, Taiwan
Objectives: To follow up the oncologic outcomes of patients who underwent nephroureterectomy with endoscopic bladder cuff excision (Pluck method) under the diagnosis of upper tract urothelial carcinoma.
Method: Between May 2004 to November 2015, 147 patients with upper urinary tract urothelial carcinoma received laparoscopic radical nephroureterectomy with endoscopic bladder cuff excision at our institution. The medical records were reviewed retrospectively for clinical and pathological facts. Statistical analyses were made for factors theoretically related to predicting oncological outcomes.
Results: The median follow-up time was 26 months. 27 patients (22.9%) developed bladder recurrence as local recurrence found in 4 cases (3.4%). Metastases were found in 17 patients (14.4%). Male gender was statistical significantly related to bladder recurrence in multivariate analysis (OR: 2.2; 95%C.I.: 1.02 - 4.78; p:0.045). Tumor size was the only predictive factor for local recurrence (mean: 5.0 cm versus 3.2 cm; OR: 1.29; 95%C.I.: 1.07 - 3.43; p:0.029). Tumor staging was related to subsequent metastasis (OR: 2.08; 95%C.I.: 1.21 - 3.56; p:0.008) and overall survival (OR: 1.84; 95%C.I.: 1.06 - 3.22 ; p:0.031).
Conclusions: In patients with upper tract urothelial carcinoma received laparoscopic nephroureterectomy with pluck method bladder cuff excision, the prognostic factor of bladder recurrence is male gender as larger tumor indicating higher risk of locoregional recurrence. Advanced staging carries higher possibility of subsequent metastasis and mortality.