European urology · 2009
Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy: a multi-institutional analysis of 1249 cases.
Сравнительное исследованиеСтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Capitanio Umberto, Shariat Shahrokh F, Isbarn Hendrik, Weizer Alon, Remzi Mesut, Roscigno Marco, Kikuchi Eiji, Raman Jay D, Bolenz Christian, Bensalah Karim, Koppie Theresa M, Kassouf Wassim, Fernández Mario I, Ströbel Philipp, Wheat Jeffrey, Zigeuner Richard, Langner Cord, Waldert Matthias, Oya Mototsugu, Guo Charles C, Ng Casey, Montorsi Francesco, Wood Christopher G, Margulis Vitaly, Karakiewicz Pierre I
Аннотация
BACKGROUND: Data regarding the oncologic efficacy of laparoscopic nephroureterectomy (LNU) compared to open nephroureterectomy (ONU) are scarce.
OBJECTIVE: We compared recurrence and cause-specific mortality rates of ONU and LNU.
DESIGN, SETTING, AND PARTICIPANTS: Thirteen centers from three continents contributed data on 1249 patients with nonmetastatic upper tract urothelial carcinoma (UTUC).
MEASUREMENTS: Univariable and multivariable survival models tested the effect of procedure type (ONU [n=979] vs LNU [n=270]) on cancer recurrence and cancer-specific mortality. Covariables consisted of institution, age, Eastern Cooperative Oncology Group (ECOG) performance status score, pT stage, pN stage, tumor grade, lymphovascular invasion, tumor location, concomitant carcinoma in situ, ureteral cuff management, previous urothelial bladder cancer, and previous endoscopic treatment.
RESULTS AND LIMITATIONS: Median follow-up for censored cases was 49 mo (mean: 62). Relative to ONU, LNU patients had more favorable pathologic stages (pT0/Ta/Tis: 38.1% vs 20.8%, p<0.001) and less lymphovascular invasion (14.8% vs 21.3%, p=0.02) and less frequently had tumors located in the ureter (64.5 vs 71.1%, p=0.04). In univariable recurrence and cancer-specific mortality models, ONU was associated with higher cancer recurrence and mortality rates compared to LNU (hazard ratio [HR]: 2.1 [p<0.001] and 2.0 [p=0.008], respectively). After adjustment for all covariates, ONU and LNU had no residual effect on cancer recurrence and mortality (p=0.1 for both).
CONCLUSIONS: Short-term oncologic data on LNU are comparable to ONU. Since LNU was selectively performed in favorable-risk patients, we cannot state with certainty that ONU and LNU have the same oncologic efficacy in poor-risk patients. Long-term follow-up data and morbidity data are necessary before LNU can be considered as the standard of care in patients with muscle-invasive or high-grade UTUC.
OBJECTIVE: We compared recurrence and cause-specific mortality rates of ONU and LNU.
DESIGN, SETTING, AND PARTICIPANTS: Thirteen centers from three continents contributed data on 1249 patients with nonmetastatic upper tract urothelial carcinoma (UTUC).
MEASUREMENTS: Univariable and multivariable survival models tested the effect of procedure type (ONU [n=979] vs LNU [n=270]) on cancer recurrence and cancer-specific mortality. Covariables consisted of institution, age, Eastern Cooperative Oncology Group (ECOG) performance status score, pT stage, pN stage, tumor grade, lymphovascular invasion, tumor location, concomitant carcinoma in situ, ureteral cuff management, previous urothelial bladder cancer, and previous endoscopic treatment.
RESULTS AND LIMITATIONS: Median follow-up for censored cases was 49 mo (mean: 62). Relative to ONU, LNU patients had more favorable pathologic stages (pT0/Ta/Tis: 38.1% vs 20.8%, p<0.001) and less lymphovascular invasion (14.8% vs 21.3%, p=0.02) and less frequently had tumors located in the ureter (64.5 vs 71.1%, p=0.04). In univariable recurrence and cancer-specific mortality models, ONU was associated with higher cancer recurrence and mortality rates compared to LNU (hazard ratio [HR]: 2.1 [p<0.001] and 2.0 [p=0.008], respectively). After adjustment for all covariates, ONU and LNU had no residual effect on cancer recurrence and mortality (p=0.1 for both).
CONCLUSIONS: Short-term oncologic data on LNU are comparable to ONU. Since LNU was selectively performed in favorable-risk patients, we cannot state with certainty that ONU and LNU have the same oncologic efficacy in poor-risk patients. Long-term follow-up data and morbidity data are necessary before LNU can be considered as the standard of care in patients with muscle-invasive or high-grade UTUC.
Предметные рубрики MeSH
AdultAgedAged, 80 and overCarcinomaCarcinoma in SituDisease-Free SurvivalFemaleFollow-Up StudiesHumansLaparoscopyLymphatic MetastasisMaleMiddle AgedMultivariate AnalysisNeoplasm Recurrence, LocalNeoplasm StagingNephrectomySurvival RateTreatment OutcomeUreteral NeoplasmsUrinary Bladder NeoplasmsUrologic Surgical Procedures