探討單純手術及手術加上輔助性治療對淋巴結轉移之上泌尿道上皮細胞癌的預後
林才揚1、李高漢1、黃冠華2、劉建良2
1奇美醫學中心 外科部 泌尿科; 2奇美醫學中心 外科部泌尿腫瘤科
Upper Tract Urothelial Carcinoma with Regional Nodal Metastasis: Comparison for the Outcome of Surgery Alone with Surgery plus Adjuvant Therapy
Chye Yang Lim1, Kau Han Lee 1 , Steven Kuan-Hua Huang 2, Chien-Liang Liu2
1 Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
2 Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.
Introduction: Upper urinary tract urothelial carcinoma (UTUC) is a relatively rare disease, comprising 5% to 10% of all urothelial tumors. Radical nephroureterectomy with bladder cuff excision remains the standard treatment for patient with UTUC. However, locally advanced UTUC still has a poor prognosis and systemic recurrences are common. Thus we evaluated the oncologic outcome in patients with UTUC and regional nodal metastasis treated with surgery alone versus surgery plus adjuvant therapy.
Patients and Methods: We retrospectively identified 37 patients with UTUC and nodal metastasis who underwent nephroureterectomy + bladder cuff excision with/without adjuvant therapy (chemotherapy or radiotherapy) between January 2012 and June 2017.
Amongst there are 17 male and 20 female patients with 70 years old in average. The patients’ demographic, clinical staging, pathology staging, treatment modalities and mortality are recorded.
Results: The primary UTUC site was renal pelvis in 24 patients (65%) and ureter in 13 patients (35%). There were 13 patients (35%) who underwent surgery alone and another 24 patients (65%) received surgery plus adjuvant therapy. Histopathological analysis indicated pN0 in 19 (51%) and pNx in 6 (16%). The median of follow up period is 23 months. For the patients who received surgery alone, 5 patients (38%) experienced recurrence and 6 patients (46%) died during follow up. Contrary, for those underwent surgery plus adjuvant therapy, 8 patients (33%) recurred and 10 patients (42 %) died.
Conclusion: The recurrence rate and survival rate were better in the patients who received surgery plus adjuvant therapy.