The Long-Term Functional and Oncologic Outcomes of Kidney-Sparing Surgery in Upper Tract Urothelial Carcinoma

被引:1
|
作者
Wang, Yu-Chieh [1 ,2 ]
Li, Jian-Ri [3 ,4 ,5 ]
Chen, Chuan-Shu [3 ,4 ,6 ]
Wang, Shian-Shiang [3 ,4 ,6 ,7 ]
Yang, Cheng-Kuang [3 ]
Chiu, Kun-Yuan [3 ,7 ]
Hsu, Chiann-Yi [8 ]
机构
[1] Taichung Vet Gen Hosp, Dept Med Educ, Taichung, Taiwan
[2] Chung Shan Med Univ, Sch Med, Taichung, Taiwan
[3] Taichung Vet Gen Hosp, Dept Urol, Dept Surg, Taichung, Taiwan
[4] Natl Chung Hsing Univ, Coll Med, Dept Postbaccalaureate Med, Taichung, Taiwan
[5] Hung Kuang Univ, Coll Nursing, Taichung, Taiwan
[6] Chung Shan Med Univ, Inst Med, Taichung, Taiwan
[7] Natl Chi Nan Univ, Dept Appl Chem, Nantou, Taiwan
[8] Taichung Vet Gen Hosp, Dept Med Res, Biostat Grp, Taichung, Taiwan
关键词
Upper tract urothelial carcinoma; Transitional cell carcinoma; Nephroureterectomy; Organ-sparing treatment; Functional outcomes; Oncological outcomes; RADICAL NEPHROURETERECTOMY;
D O I
10.1245/s10434-024-16523-y
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BackgroundThis study investigated the utilization of kidney-sparing surgery (KSS) as an alternative option to radical nephroureterectomy (RNU) in managing upper urinary tract urothelial carcinoma (UTUC) patients.ObjectiveOur study aimed to compare the functional outcomes and oncological outcomes between KSS and RNU.Material and MethodsWe retrospectively analyzed 252 patients with UTUC without clinical node positivity or metastasis who had been treated with either RNU or KSS. We collected information on each patient, including clinicopathological factors, renal function variations, and oncological outcomes. Hemodialysis-free survival (HDFS), stage 4 chronic kidney disease (CKD4) progression-free survival (PFS), recurrence-free survival (RFS), and overall survival (OS) were assessed using inverse probability of treatment weighting (IPTW)-weighted Kaplan-Meier analysis. The hazard ratio for oncological and functional outcomes of KSS was analyzed using the Cox proportional hazards model.ResultsThe OS at 8 years was 77.06% (RNU) and 70.59% (KSS) and did not significantly differ between the two groups (p = 0.691), although the KSS group experienced a higher recurrence rate. Functional outcomes indicated no significant difference in postoperative renal function at 1 year; however, KSS was associated with better preservation of renal function (23.44% vs. 28.23%), albeit not statistically significant (p = 0.055). Kaplan-Meier analysis revealed no significant disparities in CKD4 PFS between the KSS and RNU groups involved in the study (p = 0.089), although the KSS group displayed poorer HDFS than the RNU group (p = 0.001).ConclusionKSS had no compromising survival outcomes when compared with RNU, not only in low-risk patients but also in high-risk patients with a normal contralateral kidney. The efficacy of renal function preservation was presented in this study, however the results were below our expectations.
引用
收藏
页码:1354 / 1363
页数:10
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