机器人远端输尿管切除术治疗高风险远端输尿管尿路上皮癌:回顾性多中心比较分析(ROBUUST 2.0协作组)。

IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Minerva Urology and Nephrology Pub Date : 2024-06-01 DOI:10.23736/S2724-6051.24.05737-9
Francesco Ditonno, Antonio Franco, Alessandro Veccia, Eugenio Bologna, Linhui Wang, Firas Abdollah, Marco Finati, Giuseppe Simone, Gabriele Tuderti, Emma Helstrom, Andreas Correa, Ottavio DE Cobelli, Matteo Ferro, Francesco Porpiglia, Daniele Amparore, Antonio Tufano, Sisto Perdonà, Raj Bhanvadia, Vitaly Margulis, Andres Brönimann, Nirmish Singla, Dhruv Puri, Ithaar H Derweesh, Dinno F Mendiola, Mark L Gonzalgo, Reuben Ben-David, Reza Mehrazin, Sol C Moon, Soroush Rais-Bahrami, Courtney Yong, Farshad Sheybaee Moghaddam, Alireza Ghoreifi, Chandru P Sundaram, Zhenjie Wu, Hooman Djaladat, Alessandro Antonelli, Riccardo Autorino
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引用次数: 0

摘要

背景:保肾手术在高风险上尿路尿路上皮癌患者中的作用存在争议。本研究旨在评估机器人辅助远端输尿管肿瘤切除术在高危远端输尿管肿瘤患者中的肿瘤学和功能预后:这项回顾性队列分析采用了ROBUUST 2.0多中心国际数据集(2015-2022年)。输尿管远端肿瘤高危患者根据手术类型分为:机器人辅助输尿管远端切除术或机器人辅助肾切除术。对无局部复发生存率、无远处转移生存率和总生存率进行了生存分析。在对高危预后组的临床特征进行调整后,绘制了Cox比例危险模型,以评估从时间到事件结果的重要预测因素:结果:总共有477名患者接受了机器人辅助远端尿道切除术,其中58人接受了机器人辅助肾切除术,419人接受了机器人辅助肾切除术,平均(±SD)随访时间为29.6个月(±2.6)。两组患者的基线特征相当。在生存率分析中,机器人辅助远端泌尿系切除术和机器人辅助肾切除术的无复发生存率(P=0.6)、无转移生存率(P=0.5)和总生存率(P=0.7)均无明显差异。在Cox回归分析中,手术类型从来都不是较差肿瘤预后的重要预测因素。在最后一次随访中,接受机器人辅助远端尿道切除术的患者术后肾功能明显更好:结论:机器人辅助远端尿道切除术和机器人辅助肾切除术患者的无复发生存率、无转移生存率和总生存率相当,前者术后肾功能保留更好。对于选定的高风险输尿管远端UTUC患者,应考虑将保肾手术作为一种可能的选择。
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Robotic distal ureterectomy for high-risk distal ureteral urothelial carcinoma: a retrospective multicenter comparative analysis (ROBUUST 2.0 collaborative group).

Background: The role of kidney-sparing surgery in patients with high-risk upper urinary tract urothelial carcinoma is controversial. The present study aimed to assess oncological and functional outcomes of robot-assisted distal ureterectomy in patients with high-risk distal ureteral tumors.

Methods: The ROBUUST 2.0 multicenter international (2015-2022) dataset was used for this retrospective cohort analysis. High-risk patients with distal ureteral tumors were divided based on type of surgery: robot-assisted distal ureterectomy or robot-assisted nephroureterectomy. A survival analysis was performed for local recurrence-free survival, distant metastasis-free survival, and overall survival. After adjusting for clinical features of the high-risk prognostic group, Cox proportional hazard model was plotted to evaluate significant predictors of time-to-event outcomes.

Results: Overall, 477 patients were retrieved, of which 58 received robot-assisted distal ureterectomy and 419 robot-assisted nephroureterectomy, respectively, with a mean (±SD) follow-up of 29.6 months (±2.6). The two groups were comparable in terms of baseline features. At survival analysis, no significant difference was observed in terms of recurrence-free survival (P=0.6), metastasis-free survival (P=0.5) and overall survival (P=0.7) between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy. At Cox regression analysis, type of surgery was never a significant predictor of worse oncological outcomes. At last follow-up patients undergoing robot-assisted distal ureterectomy had significantly better postoperative renal function.

Conclusions: Comparable outcomes in terms of recurrence-free survival, metastasis-free survival, and overall survival between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy patients, and better postoperative renal function preservation in the former group were observed. Kidney-sparing surgery should be considered as a potential option for selected patients with high-risk distal ureteral UTUC.

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来源期刊
Minerva Urology and Nephrology
Minerva Urology and Nephrology UROLOGY & NEPHROLOGY-
CiteScore
8.50
自引率
32.70%
发文量
237
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