BMC medicine · 2026
Comparative outcomes of distal ureterectomy vs. radical nephroureterectomy in high-risk distal ureteral urothelial carcinoma: a two-center cohort study in Northern and Southern China.
СтатьяСравнительное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Xie Junyi, Liu Zhenhua, Zhou Peimin, Ye Jingwei, Ye Yunlin, Li Zhiyong, Li Xiangdong, Sun Zhoujie, Xu Chunru, Li Xuesong, He Zhisong, Hao Han, Liu Zhuowei, Yu Wei
Аннотация
BACKGROUND: This study aimed to compare radical nephroureterectomy (RNU) and distal ureterectomy (DU) in managing high-risk distal ureteral urothelial carcinoma (UC), focusing on renal function, adjuvant chemotherapy (AC), and oncologic outcomes.
METHODS: A retrospective analysis was conducted on 758 patients initially identified with high-risk distal ureteral cancer treated from 2008 to 2021 at two national centers in Beijing and Guangzhou, China. After selection, 554 patients were included: 371 in the RNU group and 183 in the DU group. Propensity score matching (PSM) was applied, resulting in 176 patients in each group. Primary outcomes included intravesical recurrence-free survival (IVRFS), extravesical recurrence-free survival (EVRFS), overall survival (OS), and cancer-specific survival (CSS). Secondary outcomes assessed associations between eGFR, AC, and survival.
RESULTS: After PSM, RNU provided better recurrence control, showing significantly higher IVRFS, particularly in T1/N- and low-grade cases, and in patients with eGFR ≥ 50 mL/min/1.73 m2. DU, however, demonstrated superior renal function preservation across all postoperative time points (p < 0.01). Higher postoperative eGFR was associated with increased AC administration and improved OS (p = 0.0010) and CSS (p = 0.0003). In advanced-stage (T2-4/N +) tumors, AC was linked to better OS (p = 0.0399) and a trend toward improved CSS. Additionally, variant histology (VH) and positive surgical margins were confirmed as significant negative prognostic factors for survival.
CONCLUSIONS: RNU is preferred for early-stage, low-grade cases due to its superior recurrence control, particularly for IVRFS. DU offers comparable outcomes in advanced-stage or high-grade cases, with the added advantage of renal preservation, supporting chemotherapy eligibility. Individualized treatment strategies based on patient-specific factors remain essential for optimizing outcomes in high-risk distal ureteral UC.
METHODS: A retrospective analysis was conducted on 758 patients initially identified with high-risk distal ureteral cancer treated from 2008 to 2021 at two national centers in Beijing and Guangzhou, China. After selection, 554 patients were included: 371 in the RNU group and 183 in the DU group. Propensity score matching (PSM) was applied, resulting in 176 patients in each group. Primary outcomes included intravesical recurrence-free survival (IVRFS), extravesical recurrence-free survival (EVRFS), overall survival (OS), and cancer-specific survival (CSS). Secondary outcomes assessed associations between eGFR, AC, and survival.
RESULTS: After PSM, RNU provided better recurrence control, showing significantly higher IVRFS, particularly in T1/N- and low-grade cases, and in patients with eGFR ≥ 50 mL/min/1.73 m2. DU, however, demonstrated superior renal function preservation across all postoperative time points (p < 0.01). Higher postoperative eGFR was associated with increased AC administration and improved OS (p = 0.0010) and CSS (p = 0.0003). In advanced-stage (T2-4/N +) tumors, AC was linked to better OS (p = 0.0399) and a trend toward improved CSS. Additionally, variant histology (VH) and positive surgical margins were confirmed as significant negative prognostic factors for survival.
CONCLUSIONS: RNU is preferred for early-stage, low-grade cases due to its superior recurrence control, particularly for IVRFS. DU offers comparable outcomes in advanced-stage or high-grade cases, with the added advantage of renal preservation, supporting chemotherapy eligibility. Individualized treatment strategies based on patient-specific factors remain essential for optimizing outcomes in high-risk distal ureteral UC.