원위부 요관의 요로상피암에 대한 개복 및 최소침습 신우요관절제술의 종양학적 결과 비교

Abstract

Purpose: We compared the oncological outcomes of patients with upper tract urothelial carcinoma who underwent open nephroureterectomy and minimally invasive nephroureterectomy after stratification by tumor location. Materials and Methods: Among 514 patients who underwent radical nephroureterectomy for upper tract urothelial carcinoma at our institution from 1998 to 2012, patients with tumor confined in distal ureter and those with tumor confined in renal pelvis were included. We excluded patients with metastatic disease, pathologic T4 or node-positive tumor, previous or concomitant bladder tumor, and positive resection margin on pathologic examination. Ultimately, a total of 270 patients (distal ureteral tumor, n=100; renal pelvic tumor, n=170) were included in present study. Kaplan–Meier and Cox proportional regression analyses were used to evaluate survival data. Results: There were more renal pelvic tumors in the minimally invasive nephroureterectomy group than the open nephroureterectomy group (70.3% vs. 53.0%, p=0.004), but clinicopathological characteristics did not differ significantly overall. More patients underwent lymph node dissection (48.7% vs. 20.0%, p<0.001) in the open nephroureterectomy group. In patients with distal ureteral tumors, 5-year intravesical recurrence-free survival (37.3% vs. 41.4%, p=0.242), extravesical recurrence-free survival (63.9% vs. 71.1%, p=0.606), and overall survival (66.1% vs. 73.8%, p=0.166) rates did not differ between the 2 groups. In patients with renal pelvic tumors, the 5-year intravesical recurrence-free survival rate was lower in the open nephroureterectomy group (45.1% vs. 69.4%, p=0.001). Five-year extravesical recurrence-free survival (89.1% vs. 87.0%, p=0.738) and overall survival (83.5% vs. 83.8%, p=0.256) rates were comparable. Multivariable Cox proportional regression analysis showed that surgical approach was a risk factor for intravesical recurrence in patients with renal pelvic tumors (hazard ratio 0.50, p=0.006) and overall mortality in those with distal ureteral tumors (hazard ratio 0.46, p=0.032). Conclusions: Minimally-invasive nephroureterectomy was not associated with poorer intravesical and extravesical recurrence-free survival or overall survival, even in patients with distal ureteral tumor.