Abstract：
BACKGROUND: The role of kidney-sparing surgery in patients with high-risk upper urinary tract urothelial carcinoma is controversial. The present study aimed to assess oncological and functional outcomes of robot-assisted distal ureterectomy in patients with high-risk distal ureteral tumors.
METHODS: The ROBUUST 2.0 multicenter international (2015-2022) dataset was used for this retrospective cohort analysis. High-risk patients with distal ureteral tumors were divided based on type of surgery: robot-assisted distal ureterectomy or robot-assisted nephroureterectomy. A survival analysis was performed for local recurrence-free survival, distant metastasis-free survival, and overall survival. After adjusting for clinical features of the high-risk prognostic group, Cox proportional hazard model was plotted to evaluate significant predictors of time-to-event outcomes.
RESULTS: Overall, 477 patients were retrieved, of which 58 received robot-assisted distal ureterectomy and 419 robot-assisted nephroureterectomy, respectively, with a mean (±SD) follow-up of 29.6 months (±2.6). The two groups were comparable in terms of baseline features. At survival analysis, no significant difference was observed in terms of recurrence-free survival (P=0.6), metastasis-free survival (P=0.5) and overall survival (P=0.7) between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy. At Cox regression analysis, type of surgery was never a significant predictor of worse oncological outcomes. At last follow-up patients undergoing robot-assisted distal ureterectomy had significantly better postoperative renal function.
CONCLUSIONS: Comparable outcomes in terms of recurrence-free survival, metastasis-free survival, and overall survival between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy patients, and better postoperative renal function preservation in the former group were observed. Kidney-sparing surgery should be considered as a potential option for selected patients with high-risk distal ureteral UTUC.
METHODS: The ROBUUST 2.0 multicenter international (2015-2022) dataset was used for this retrospective cohort analysis. High-risk patients with distal ureteral tumors were divided based on type of surgery: robot-assisted distal ureterectomy or robot-assisted nephroureterectomy. A survival analysis was performed for local recurrence-free survival, distant metastasis-free survival, and overall survival. After adjusting for clinical features of the high-risk prognostic group, Cox proportional hazard model was plotted to evaluate significant predictors of time-to-event outcomes.
RESULTS: Overall, 477 patients were retrieved, of which 58 received robot-assisted distal ureterectomy and 419 robot-assisted nephroureterectomy, respectively, with a mean (±SD) follow-up of 29.6 months (±2.6). The two groups were comparable in terms of baseline features. At survival analysis, no significant difference was observed in terms of recurrence-free survival (P=0.6), metastasis-free survival (P=0.5) and overall survival (P=0.7) between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy. At Cox regression analysis, type of surgery was never a significant predictor of worse oncological outcomes. At last follow-up patients undergoing robot-assisted distal ureterectomy had significantly better postoperative renal function.
CONCLUSIONS: Comparable outcomes in terms of recurrence-free survival, metastasis-free survival, and overall survival between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy patients, and better postoperative renal function preservation in the former group were observed. Kidney-sparing surgery should be considered as a potential option for selected patients with high-risk distal ureteral UTUC.
摘要：
背景：保留肾脏手术在高危上尿路尿路上皮癌患者中的作用存在争议。本研究旨在评估高风险输尿管远端肿瘤患者机器人辅助输尿管远端切除术的肿瘤和功能结果。
方法：本回顾性队列分析使用ROBUUST2.0多中心国际（2015-2022）数据集。根据手术类型将输尿管远端肿瘤的高危患者分为：机器人辅助的输尿管远端切除术或机器人辅助的肾输尿管切除术。对局部无复发生存率进行生存分析，无远处转移生存率，和总体生存率。在调整了高危预后组的临床特征后，绘制Cox比例风险模型以评估事件发生时间结局的重要预测因子。
结果：总体而言，检索到477名患者，其中58例接受了机器人辅助的远端输尿管切除术和419例机器人辅助的肾输尿管切除术，分别,平均（±SD）随访29.6个月（±2.6）。两组在基线特征方面具有可比性。在生存分析中，在无复发生存率方面没有观察到显著差异（P=0.6），机器人辅助远端输尿管切除术和机器人辅助肾输尿管切除术之间的无转移生存率（P=0.5）和总生存率（P=0.7）。在Cox回归分析中，手术类型从来都不是肿瘤预后较差的重要预测指标.末次随访时，接受机器人辅助远端输尿管切除术的患者术后肾功能明显更好。
结论：无复发生存率方面的结果相当，无转移生存率，机器人辅助的远端输尿管切除术和机器人辅助的肾输尿管切除术患者之间的总生存率，观察到前组术后肾功能保存较好。对于某些高危输尿管远端UTUC患者，应考虑保留肾脏手术作为潜在选择。
方法：本回顾性队列分析使用ROBUUST2.0多中心国际（2015-2022）数据集。根据手术类型将输尿管远端肿瘤的高危患者分为：机器人辅助的输尿管远端切除术或机器人辅助的肾输尿管切除术。对局部无复发生存率进行生存分析，无远处转移生存率，和总体生存率。在调整了高危预后组的临床特征后，绘制Cox比例风险模型以评估事件发生时间结局的重要预测因子。
结果：总体而言，检索到477名患者，其中58例接受了机器人辅助的远端输尿管切除术和419例机器人辅助的肾输尿管切除术，分别,平均（±SD）随访29.6个月（±2.6）。两组在基线特征方面具有可比性。在生存分析中，在无复发生存率方面没有观察到显著差异（P=0.6），机器人辅助远端输尿管切除术和机器人辅助肾输尿管切除术之间的无转移生存率（P=0.5）和总生存率（P=0.7）。在Cox回归分析中，手术类型从来都不是肿瘤预后较差的重要预测指标.末次随访时，接受机器人辅助远端输尿管切除术的患者术后肾功能明显更好。
结论：无复发生存率方面的结果相当，无转移生存率，机器人辅助的远端输尿管切除术和机器人辅助的肾输尿管切除术患者之间的总生存率，观察到前组术后肾功能保存较好。对于某些高危输尿管远端UTUC患者，应考虑保留肾脏手术作为潜在选择。
