| Objective:To evaluate the clinical effect of local high-grade ureteral urothelial carcinoma treated with kidney-sparing surgery,and compare it with radical surgery.To identify the feasibility of kidney-sparing surgery for patients with local high-grade ureteral urothelial carcinoma,and analyse the prognostic factors.Methods:The clinical data of patients with local high-grade ureteral urothelial carcinoma patients undergoing surgical treatment from January 2013 to December 2018 in our hospital were selected and divided into radical nephroureterectomy(RNU)group and partial nephroureterectomy(PU)group according to surgical methods.We collected the general condition of patients and postoperative follow-up.The measurement data of normal or nearly normal distribution is expressed by mean±standard deviation,and the non-normal distribution is expressed by median and interquartile range.The mean comparison between the two samples was performed using the independent sample t-test.Counting data is expressed by the number of cases in each subgroup with chi-square test.To evaluated the overall survival rate,tumor-specific survival rate,relapse-free survival rate and bladder recurrence rate of patients with tumors by Kaplan-Meier method,examining with Log-rank test.The Cox regression model was used to understand and analyze the influencing factors of OS and CSS after ureteral urothelial carcinoma surgery,and to determine whether the surgical method related to tumor prognosis with further study.Statistical analysis were performed by SPSS 22.0 software.Results:(1)A total of 133 patients were selected in this study.There were 101 cases in the RNU group,including T1: 38 cases,T2: 26 cases,T3: 36 cases,and T4: 1 case,and a total of 32 cases in the PU group,including T1: 22 cases,T2: 7 cases,and T3: 3 cases.There was no difference in gender,tumor location,ipsilateral hydronephrosis,hypertension,smoking history,BMI and lymph node infiltration between the two groups of patients(P>0.05).(2)There were more elderly patients in PU group than RNU group,with statistical difference(P=0.002).There were more diabetic patients in the PU group than in the RNU group,with statistical difference(P=0.028).There were more PU patients in the coronary heart disease than in the RNU group(P= 0.026).and there were more PU patients with renal insufficiency than in the RNU group,with significant differences(P=0.035).The PU group had more high ECOG score patients than RNU group,with statistical differences(P=0.046).(3)The operation time and bleeding volume of RNU group and PU group were 161.25 ± 48.59 min vs 109.43 ± 38.46 min,203.27 ± 79.08 ml vs 135.06 ± 40.87 ml respectively,the differences between the two groups were statistically significant(P <0.001).(4)The follow-up period ranged from 4 to 83 months,with a average follow-up time of 36.7 months.A total of 29 patients died in the RNU group,and 24 patients died from tumors among them,36 patients had tumor recurrence,and 21 cases had bladder recurrence among them.In the PU group,8 patients died,and 5 patients died from tumors.19 patients had tumor recurrence,and 12 of them had bladder recurrence.The 5-year overall survival rate(OS)of the RNU group was 60.7%;the 5-year overall survival rate of the PU group was 56.3%,and there was no statistically significant difference between the two groups(P = 0.991).The 5-year cancer-specific survival rate(CSS)in the RNU group was 68.3%,and the cancer-specific survival rate in the PU group was 62.7%.There was no statistically significant difference between the two groups(P = 0.546).The relapse-free survival rate and the bladder tumor-free recurrence rates between the PU group and the RNU group were statistically different,with P values of 0.002 and 0.010,respectively.(5)Univariate analysis showed that the surgical method(RNU versus PU)was not related to the patient's OS and CSS(P > 0.05),while the pathological stage,smoking history was significantly related to OS and CSS,and ECOG score was only significantly related to OS(P = 0.009),having nothing to do with CSS(P = 0.100).Cox multivariate analysis showed that patients with high pathological stage had shorter survival time(HR: 2.115,95% CI: 1.037-4.310,P = 0.039;HR: 2.503,95% CI: 1.106-5.664,P = 0.028),Smoking patients had a shorter survival time(HR: 2.520,95% CI: 1.290-4.925,P = 0.007;HR: 2.470,95% CI: 1.171-5.208,P = 0.018),and patients with high ECOG scores had lower overall survival rates(HR: 2.426,95% CI: 1.211-4.861,P = 0.012).Smoking and pathological stage were independent predictors of OS and CSS(P <0.05),and ECOG was independent predictor of OS(P <0.05).Conclusions:The overall survival rate and cancer-specific survival rate of patients with local high-grade ureteral urothelial carcinoma after partial ureterectomy are similar to radical ureterectomy,and the surgical method is not a risk factor that affects the prognosis.Partial ureteral resection is less invasive and retains more nephrons.It might be a potentially beneficial treatment for patients with high ECOG score,comorbidities,and renal insufficiency.However,there is a higher risk of local / bladder recurrence after surgery.Postoperative follow-up should be strengthened.In addition,tumor stage and smoking history are independent risk factors for the prognosis of high-grade ureteral urothelial carcinoma.Early diagnosis and appropriate surgical treatment and postoperative smoking cessation may improve the patient's prognosis. |
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