泌尿科
尿路上皮癌
肾功能
医学
多中心研究
内科学
癌症
膀胱癌
随机对照试验
作者
Alberto Abrate,Francesco Sessa,Riccardo Campi,Mirko Preto,Alberto Olivero,Virginia Varca,Andrea Benelli,Maurizio Sessa,Arcangelo Sebastianelli,Carlo Pavone,Vincenzo Serretta,Marco Vella,Eugenio Brunocilla,Sergio Serni,Carlo Trombetta,Carlo Terrone,Andrea Gregori,A. Lissiani,Paolo Gontero,Riccardo Schiavina,Mauro Gacci,Alchiede Simonato
标识
DOI:10.1016/j.urolonc.2020.03.005
摘要
To compare segmental ureterectomy (SU) and radical nephroureterectomy (RNU) in terms of overall survival (OS) and impact on postoperative renal function in patients treated for upper tract urothelial carcinoma (UTUC) of the ureter with preoperatively reduced estimated glomerular filtration rate (eGFR).We retrospectively collected the data of consecutive patients treated for UTUC, in 6 Italian tertiary referral centers, from 2003 to 2013, and analyzed those treated with RNU or SU for ureteral cancer and with a preoperative eGFR <90 ml/min/1.73m2. The primary outcome was to compare the postoperative eGFR variation and the OS according to the surgical technique chosen.Out of 521 patients with UTUC, 228 patients had preoperative reduced eGFR. Out of these patients, 93 had ureteral cancer and were included in the primary analyses - 67 (72.0%) treated with RNU and 26 (28.0%) with SU. Preoperative characteristics were similar in the 2 groups. The overall median follow-up period was 26.5 months. A nonsignificant postoperative eGFR decrease of 3.0 ml/min/1.73m2 was found overall (P = 0.094), with nonsignificant difference between the 2 groups (P = 0.735). A comparable 5-year OS was calculated for RNU and SU patients (P = 0.99).The type of surgery (SU vs. RNU) has a low impact on postoperative renal function and OS in patients with ureteral cancer and preoperative eGFR <90 ml/min/1.73m2. The indications for kidney sparing surgery for UTUC should be based on the surgical and oncological risks in these patients.
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