目标:尽管保留肾脏手术(KSS)是低风险上尿路尿路上皮癌(UTUC)的非次要选择,与根治性肾输尿管切除术(RNU)相比,其在高危UTUC中的肿瘤获益尚不清楚.本研究旨在比较RNU和KSS在UTUC患者中的肿瘤学结果。
方法:我们在SEER数据库中搜索了2004年至2018年间使用RNU或保留肾脏方法(节段性输尿管切除术(SU)或局部肿瘤切除术(LTE))治疗原发性非转移性UTUC的患者。
结果:该研究包括6,659例接受手术治疗的原发性非转移性UTUC患者;2,888例(43.4%)和3,771例(56.6%)患者表现为输尿管和肾盂肿瘤,分别。最后,5,479例(82.3%)患者接受RNU,799(12.0%)用SU治疗,381例(5.7%)患者接受LTE.对于混杂控制,对SU和RNU治疗的患者进行倾向评分匹配(PSM)以调整T分期,grade,年龄,性别,肿瘤大小,和淋巴结清扫术的表现。PSM分析包括694例接受RNU治疗的患者和694例接受SU治疗的患者。在多变量Cox回归和Kaplan-Meier分析中,我们发现RNU和SU之间的CSS或OS没有区别,即使在高级别和/或肌肉浸润性UTUC亚组,包括pT3-T4肿瘤(均p>0.05)。
结论:在这项基于人群的研究中,与RNU相比,SU提供等效的CSS和OS,即使是高危和局部晚期输尿管癌。由于不可避免的选择偏差风险,进一步的前瞻性研究有望克服本研究的局限性,并支持KSS的更广泛实施.
Although kidney-sparing surgery (KSS) is a nonminor option for low-risk upper urinary tract urothelial cancer (UTUC), its oncological benefits in high-risk UTUC remain unclear when compared to radical nephroureterectomy (RNU). This study aimed to compare the oncological outcomes of RNU and KSS in patients with UTUC.
We searched the SEER database for patients treated for primary non-metastatic UTUC with either RNU or a kidney-sparing approach (segmental ureterectomy (SU) or local tumor excision (LTE)) between 2004 and 2018.
The study included 6,659 patients with primary non-metastatic UTUC treated with surgery; 2,888 (43.4%) and 3,771 (56.6%) patients presented with ureteral and renal pelvicalyceal tumors, respectively. Finally, 5,479 (82.3%) patients underwent RNU, 799 (12.0%) were treated with SU, and 381 (5.7%) patients received LTE. For confounder control, propensity score matching (PSM) of patients treated with SU and RNU was performed to adjust for T stage, grade, age, gender, tumor size, and lymphadenectomy performance. PSM analysis included 694 patients treated with RNU and 694 individuals who underwent SU. In multivariable Cox regression and Kaplan-Meier analyses, we found no difference in either CSS or OS between RNU and SU, even in the subgroup of high-grade and/or muscle-invasive UTUC including pT3-T4 tumors (all p > 0.05).
In this population-based study, SU provides equivalent CSS and OS compared to RNU, even in high-risk and locally advanced ureteral cancer. Due to the unavoidable risk of selection bias, further prospective studies are expected to overcome the limitations of this study and support the wider implementation of KSS.