术前输尿管镜检查对上尿路尿路上皮癌患者根治术后预后的影响

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Effects of preoperative ureteroscopy on the prognosis of patients with upper tract urothelial carcinoma after radical nephroureterectomy

LUO Xingxing1，2，3，YE Jianjun1，3，WANG Qihao1，3，ZHENG Lei1，3，BAO Yige1

（1.Department of Urology，Institute of Urology，West China Hospital，Sichuan University，Chengdu 610041;2.Department of Urology，Fushun County People's Hospital，Zigong 643200;3.West China School of Medicine，Sichuan University，Chengdu 610041，China）

ABSTRACT：Objective To evaluate the effects of preoperative ureteroscopy （URS） on the prognosis of patients with upper tract urothelial carcinoma （UTUC） after radical nephroureterectomy （RNU）.Methods Data of 712 UTUC patients who received RNU in West China Hospital during May 2003 and Jun.2019 were retrospectively analyzed. Patients were divided into URS group （n=187） and non-URS group （n=525） according to whether URS was performed before RNU. Kaplan-Meier curves were used to analyze the overall survival （OS），cancer-specific survival （CSS），and intravesical recurrence-free survival （IVRFS）. Cox proportional risk model was used for risk assessment. Subgroup analysis and interaction test were used to further verify the results.Results Significant differences were observed between the two groups in terms of body mass index （BMI），diabetes mellitus，surgical method，hydronephrosis，tumor location，tumor grade，lymph node metastasis，lymphovascular invasion and tumor diameter （P＜0.05）. Kaplan-Meier survival analysis showed that IVRFS was significantly lower in the URS group than in the non-URS group （P＜0.001），and the difference was more pronounced in renal pelvis carcinoma （P＜0.001）; there were no differences in OS and CSS between the two groups （P＞0.05）. Cox multivariate regression showed that URS was an independent risk factor for intravesical recurrence （HR=2.12，95%CI：1.34-3.36，P＜0.001）.Conclusion Preoperative URS can increase the recurrence rate of UTUC，but it has no effect on the OS and CSS.

KEY WORD：upper tract urothelial carcinoma; ureteroscopy; radical nephroureterectomy; intravesical recurrence; overall survival; cancer-specific survival; intravesical recurrence-free survival

摘要：目的 探讨在根治性肾输尿管切除术（RNU）前行输尿管镜检查（URS）对上尿路尿路上皮癌（UTUC）患者预后的影响。（剩余8394字）