台湾上尿路上皮癌微创与开放式根治性肾输尿管切除术之存活率比较。

IF 2.9 2区 医学 Q2 UROLOGY & NEPHROLOGY
I-Hsuan Alan Chen, Wei-Ming Li, Hung-Lung Ke, Yi-Huei Chang, Chao-Hsiang Chang, Yao-Chou Tsai, Chih-Chin Yu, Wun-Rong Lin, Marcelo Chen, Yi-Hsin Lu, Chia-Cheng Yu
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引用次数: 0

摘要

目的:上尿路上皮癌(UTUC)在全球罕见,但在台湾占30-40%的尿路上皮癌。根治性肾输尿管切除术(RNU)联合膀胱袖切除术(BCE)仍然是局部或局部晚期疾病的标准治疗方法。尽管越来越多地采用微创手术(MIS)方法,但对其肿瘤预后的担忧仍然存在。本研究使用倾向-评分匹配(PSM)分析评估MIS与开放RNU治疗UTUC的比较生存结果。方法:回顾性分析台湾UTUC协作组1988年至2022年间治疗的2430例UTUC患者的数据。PSM用于最小化基线差异。主要终点是总生存期(OS)、癌症特异性生存期(CSS)和无病生存期(DFS)。Kaplan-Meier估计、分层对数秩检验和Cox比例风险模型用于评估生存结果。结果:经PSM后,1758例患者(1172例MIS;586个开放)被包括在内。MIS组OS明显改善(OR: 0.662;结论:MIS入路,包括腹腔镜和机器人RNU,在UTUC中提供与开放式RNU相当或更好的肿瘤预后。这些发现支持MIS技术的广泛采用,强调细致的BCE以确保肿瘤控制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparative survival outcomes of minimally invasive versus open radical nephroureterectomy for upper tract urothelial carcinoma in Taiwan.

Purpose: Upper tract urothelial carcinoma (UTUC) is rare globally but accounts for 30-40% of urothelial cancers in Taiwan. Radical nephroureterectomy (RNU) with bladder cuff excision (BCE) remains the standard of care for localized or locally advanced disease. Despite the increasing adoption of minimally invasive surgical (MIS) approaches, concerns about their oncological outcomes persist. This study evaluates the comparative survival outcomes of MIS versus open RNU for UTUC using propensity-score-matched (PSM) analysis.

Methods: Data from 2430 patients with UTUC, treated between 1988 and 2022 within the Taiwan UTUC Collaboration Group, were retrospectively analyzed. PSM was employed to minimize baseline differences. The primary endpoints were overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Kaplan-Meier estimates, stratified log-rank tests, and Cox proportional hazards models were used to evaluate survival outcomes.

Results: After PSM, 1758 patients (1172 MIS; 586 open) were included. The MIS group demonstrated significantly improved OS (OR: 0.662; p < 0.001), CSS (OR: 0.659; p = 0.002), and DFS (OR: 0.646; p < 0.001) compared to the open group. MIS was associated with superior survival despite a higher prevalence of high-grade tumors and adverse pathological features.

Conclusion: MIS approaches, including laparoscopic and robotic RNU, offer oncological outcomes comparable to or better than open RNU in UTUC. These findings support the broader adoption of MIS techniques, emphasizing meticulous BCE to ensure oncological control.

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来源期刊
World Journal of Urology
World Journal of Urology 医学-泌尿学与肾脏学
CiteScore
6.80
自引率
8.80%
发文量
317
审稿时长
4-8 weeks
期刊介绍: The WORLD JOURNAL OF UROLOGY conveys regularly the essential results of urological research and their practical and clinical relevance to a broad audience of urologists in research and clinical practice. In order to guarantee a balanced program, articles are published to reflect the developments in all fields of urology on an internationally advanced level. Each issue treats a main topic in review articles of invited international experts. Free papers are unrelated articles to the main topic.
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