| Title | Segmental ureterectomy can be performed safely in patients with urothelial carcinoma of distal ureter |
| Authors | Jia, Zhuo Gong, Yan-Qing Zhang, Cui-Jian Bao, Zheng-Qing Li, Xue-Song Hao, Han Xiong, Geng-Yan Zhang, Lei Fang, Dong He, Zhi-Song Zhou, Li-Qun |
| Affiliation | Peking Univ, Dept Urol, Inst Urol, Hosp 1, Beijing, Peoples R China Peking Univ, Natl Urol Canc Ctr, Beijing, Peoples R China |
| Issue Date | 2019 |
| Publisher | CUAJ-CANADIAN UROLOGICAL ASSOCIATION JOURNAL |
| Abstract | Introduction: We aimed to compare oncological outcomes by surgery type (segmental ureterectomy [SU] vs. radical nephroureterectomy [RNU]) in a large cohort of patients with upper tract urothelial carcinoma (UTUC) of the distal ureter. Methods: We performed a retrospective analysis of 219 patients with UTUC of the distal ureter among 931 patients with UTUC who underwent SU and RNU. Clinicopathological outcomes were evaluated. Cancer-specific survival (CSS), overall survival (OS), local recurrence-free survival (RFS), intravesical recurrence-free survival (IVRFS), contralateral recurrence-free survival, and distal metastasis-free survival were assessed by the Kaplan-Meier method and Cox regression, estimating hazard ratios (HR) and 95% confidence intervals (CIs). Results: A total of 179 (81.7%) patients underwent RNU and 40 (18.3%) underwent SU: 85 males (47.5%) with RNU and 17 (42.5%) with SU (p=0.568). The median age with RNU and SU was 71 years (range 31-86) and 70 years (range 46-90), respectively (p=0.499). The T stage of the two groups did not differ (p=0.122), nor did mean tumor length (3.35 +/- 2.62 vs. 3.25 +/- 2.14; p=0.953), grade (p=0.075), tumor necrosis (p=0.634), or followup time (months) (58.1 +/- 8.1 vs. 63.7 +/- 3.4; p=0.462). The two groups did not differ in CSS (p=0.358) or OS (p=0.206), and surgery type did not predict CSS (HR 0.862; 95% CI 0.469-1.585; p=0.633) or OS (HR 0.764; 95% CI 0.419-1.392; p=0.379). Local RFS was higher with RNU than SU (96.2% vs. 86.0%; p=0.02), but the groups did not differ in IVRFS (p=0.661), contralateral RFS (p=0.183), or distant metastasis-free survival (p=0.078). On multivariate analysis, SU was associated with local RFS (HR 5.069; 95% CI 1.029-24.968; p=0.046) and distant metastasis-free survival (HR 6.497; 95% CI 1.196-35.283; p=0.03). Local RFS was lower with SU than RNU for patients with pT3-4 stage (p=0.006). Conclusions: Long-term oncological outcomes were equivalent with SU and RNU in patients with UTUC of the distal ureter. SU affected local recurrence survival, especially with advanced tumor stage, and distant metastasis survival. |
| URI | http://hdl.handle.net/20.500.11897/547032 |
| ISSN | 1911-6470 |
| DOI | 10.5489/cuaj.5555 |
| Indexed | SCI(E) EI |
| Appears in Collections: | 第一医院 |
