Cancer - Bladder, Pelvis, Ureter & Others(구연) (E-072)

상부요로상피세포암 환자에서 근치신요관절제술 후 잔존요관구가 방광내 재발에 미치는 영향
동국대학교 경주병원, 영남대학교병원, 계명대학교 동산병원, 경북대학교병원, 칠곡경북대학교병원
권세윤¹, 고영휘², 송필현², 김병훈³, 김범수⁴, 김태환5
Objectives: To investigate the impact of the remnant ureteral orifice (RUO) on the prognosis of upper tract urothelial carcinoma (UTUC), because the presence of an ipsilateral intact ureteral orifice is not an uncommon finding during follow-up cystoscopy despite the clinical relevance of bladder cuffing during radical nephroureterectomy (RNU) for the management of UTUC.

Methods: The records of patients who underwent RNU in all tertiary hospitals in Daegu province (2011-2018) were retrospectively reviewed. Subjects were allocated to RUO or non-RUO groups. Cox proportional hazard models were used to identify variables. The primary endpoint was a five-year intravesical recurrence-free survival (RFS).

Results: Of the 164 patients enrolled, 45 (27.4%) had an RUO by postoperative cystoscopy. The characteristics of the RUO and non-RUO groups were similar. During mean follow-up of 76.4 months (range: 69.5~83.4), 21 (46.7%) subjects in the RUO group and 25 (21.0%) in the non-RUO group experienced intravesical recurrence (p=0.001). Among them, 3 (6.7%) and 14 (8.5%) developed distant metastasis (p=0.339), and 3 (6.7%) and 9 (7.6%) succumbed to UTUC (p=0.844), respectively. The 5-year RFS was lower in the RUO group than in the non-RUO counterpart (45.6% vs. 77.8%, p=0.003). Multivariate analysis showed lymphovascular invasion (HR=3.593, p=0.002), lymph nodal involvement (HR=2.336, p=0.038), and the presence of RUO (HR=2.058, p=0.026) predicted 5-year RFS.

Conclusions: The presence of RUO after RNU was found to be significantly associated with intravesical tumor recurrence, and this finding emphasizes the quality of bladder cuffing during RNU, which could be assessed by complete removal of the natural orifice.
keywords : upper tract urothelial carcinoma; nephroureterectomy; bladder cuffing; tumor recurrence

프린트