术前输尿管镜检查对上尿路上皮癌根治术后膀胱复发的影响

Effects of preoperative ureteroscopy on intravesical recurrence after radical nephroureterectomy of upper tract urothelial carcinoma

目的探讨术前输尿管镜检查(URS)对上尿路上皮癌(UTUC)患者根治术后膀胱内复发(IVR)的影响。方法回顾性分析2012年5月-2020年1月于兰州大学第二医院收治的241例UTUC患者的临床资料,分为根治性肾输尿管切除术(RNU)前行URS(URS组)和RNU前未行URS(非URS组),比较RNU后累积IVR率、无进展生存期(PFS)和总生存期(OS),并绘制生存曲线。采用Cox比例风险模型分析URS对UTUC患者术后IVR的影响。结果纳入UTUC患者241例,URS组64例(26.6%),非URS组177例(73.4%)。URS组64例患者中49例行活检,15例未行活检。所有患者中位随访时间44(3~122)个月,中位复发时间12(3~56)个月,URS组18例(28.1%)发生IVR,非URS组25例(14.1%)发生IVR。Kaplan-Meier生存分析显示,无论是否排除合并膀胱癌(BC)或BC病史患者,URS组累积IVR率均高于非URS组(P均<0.05),而URS组PFS低于非URS组(P=0.007)。Cox多因素回归分析结果显URS(P=0.031)及肾盂合并输尿管肿瘤(P=0.004)是IVR的独立危险因素。结论UTUC患者术前行URS会增加IVR的发生率,不建议术前常规使用URS。

Objective To investigate the effects of preoperative ureteroscopy(URS)on the intravesical recurrence(IVR)in patients with upper tract urothelial carcinoma(UTUC)after radical nephroureterectomy(RNU).Methods The clinical data of 241 UTUC patients treated during May 2012 and Jan.2020 in the Second Hospital of Laozhou University were retrospectively analyzed.The patients were divided into URS before RNU group(URS group)and non-URS before RNU group(non-URS group).The cumulative IVR rate,progression-free survival(PFS)and overall survival(OS)after RNU were compared,and the survival curve was drawn.Cox proportional hazards models were used to assess risk factors affecting IVR.Results Of the 241 patients,64(26.6%)were included in the URS group and 177(73.4%)in the non-URS group.In the URS group,49 underwent biopsy and 15 did not.All patients were followed up for a median of 44(3 to 122)months,with a median time to recurrence of 12(3 to 56)months.IVR occurred in 18 patients(28.1%)in the URS group and 25(14.1%)in the non-URS group.Kaplan-Meier survival analysis showed that the cumulative IVR rate was higher in the URS group than in the non-URS group(all P<0.05),regardless of whether patients had a history of bladder cancer(BC)or not,while PFS was lower in the URS group than in the non-URS group(P=0.007).Cox multivariate regression analysis showed that URS(P=0.031)and complicated renal pelvis tumor and ureteral tumor(P=0.004)were independent risk factors for IVR.Conclusion Pre operative URS increases the incidence of IVR in patients with UTUC,and routine preoperative use of URS is not recommended.