Oncologic Outcomes Of Organ-preserving Surgeries For Urothelial Cell Carcinomas

ObjectiveTo evaluate oncologic outcomes of segmental ureterectomy(SU)compared with radical nephroureterectomy(RNU) for ureter urothelial carcinoma of stage Ta,T1 and T2. To evaluate whether tumor position is a factor to influence outcomes of different surgical procedures.Materials and MethodsFrom December 2004 to August 2014, 81 patients with non-locally-advanced(Ta, T1 or T2) urothelial carcinoma of ureter underwent SU or RNU at our department. We used Kaplan-Meier survival analysis and Cox regression models to compare oncologic outcomes after SU and RNU. Covariates included surgical type, tumor stage, cancer grade,lesion position, presence of preoperative hydronephrosis and histories of bladder cancer. Patients were divided according to lesion sites for furthercomparison.ResultsThe mean length of follow-up was 55.3 and 50.9 months for the RNU and SU group, respectively. Overall cancer-specific 5 years CSS is 72.7% while72.3% for RNU, 73.8% for SU, respectively. There exists no significant difference of 5-year CSS between the two groups(p = 0.763). 11 patients were found upper urinary tract recurrence, with a local recurrence rate of32.4%. RNU group found no local recurrence.The bladder recurrences,distant metastasis, cancer-specific survival and overall survival rates showed no significant differences between RNU and SU(p=0.596,p=0.740, p=0.809,p=0.553, respectively). For Mid-ureter or Distal-ureter lesions, no significant difference of oncologic outcomes between SU and RUN was observed.ConclusionsOur study suggested that for UUT-TCCs within stage Ta,T1 or T2,SU is not inferior to RNU. Cancer of distal ureter has better oncologic outcomes while the differece is not caused by surgical types.ObjectiveTo evaluate oncologic outcomes of partial cystectomy(PC) compared with radical cystectomy(RC) for treating muscle-invasive bladder carcimonas(MIBC).Materials and MethodsFrom November 2004 to August 2014, 252 patients with muscle-invasive bladder carcinomas underwent PC or RC at our department. PC group consists of 178 cases(130 cases for stage T2, 29 for T3, 9 for T4); RC group consists of 54 cases(11 cases for stage T2, 31 for T3, 12 for T4). We use Kaplan-Meier survival analysis to evaluate whether significant difference of oncologic outcomes exist between PC and RC. We also established Cox regression model for multivarite analysis.ResultsThe length of follow-up ranged 7-97(54.3 ± 13.2) months. Overall cancer-specific 5 years CSS is 67.3% while 69.2% for PC, 57.7% for RC,respectively. There are significant difference of 5-year CSS between the two groups(p = 0.017). There are seletive bias due to the significant difference of baseline data between the two groups. Multivariate analysis show that surgical type(PC or RC) is not independent factor influencing survival and recurrence of MIBC. Advanced tumor stage, bladder cancer history, invasive growth and vascular invasion are independent prognostic factors for MIBC survival. Advanced stage, bladder cancer history, tumor invasive growth and tumor number > 3 were independent prognostic factors for recurrence after PC.ConclusionsOur research shows that surgical approach(PC or RC) is not the independent factor influencing the prognosis of MIBC.