於上泌尿道泌尿細胞癌病人術前進行經皮穿腎引流不會改變腫瘤預後
黃冠霖、羅浩倫、鄭元佐
高雄長庚紀念醫院
Preoperative percutaneous nephrostomy insertion does not alter upper-tract urothelial cancer control
Guan-Lin Huang, Hao-Lun Luo, Yantso Cheng
Kaohsiung Chang Gung Memorial hospital
Purpose:
Physicians doubt PCN insertion on cancer related hydronephrosis patients causes tumor seeding and worse cancer control. In this article, we attempt to determine if preoperative PCN alters cancer control in UTUC patients.
Materials and Methods:
Retrospective analysis of UTUC patients in a single center from 2005 to 2015. Exclusion criteria included lymph node metastasis, and patients underwent perioperative adjuvant chemotherapy or radiotherapy. There were 664 patients in this analysis, with clinico-pathological data being collected retrospectively for analysis. Outcomes were measured by local recurrence, distant metastasis and cancer-specific death.
Results:
There were respectively 25 and 639 UTUC cancers in the preoperative PCN and non-PCN insertion groups with mean follow-up duration of 37.9 and 48.6 months, respectively. The preoperative PCN group consisted of 17 patients (68%) with tumor located in the ureter, while the PCN-negative group included 236 patients (36%) with tumor located in the ureter being statistically significant. These two groups were comparable in gender, age, follow-up duration, tumor stage, and pathological features of the UTUC. As for the cancer control in the PCN group, 4(16%), 1(4%) and 1(4%) had local recurrence, distant metastasis and cancer-specific death respectively; in the non-PCN group, 101(15.8%), 96(15%) and 72(11.2%) exhibited local recurrence, distant metastasis and cancer-specific death respectively. Statistical analysis showed no cancer control difference in these two groups.(p=0.804, 0.201 and 0.254)
Conclusion:
In our preliminary retrospective data, PCN-related tumor-seeding concern should be downplayed when regarding preserving of the renal function in upper-tract urothelial cancer patients.