A Study On The Efficacy Of Surgical Methods For The Prognosis Of Upper Urinary Tract Urothelial Carcinoma

【Objective】 Upper urinary tract urothelial carcinoma(UUT-UC)accounts for approximately 5% of all urogenital tumors.In recent years,advances in surgical methods have also brought problems and controversies.This study retrospectively evaluated the effect of surgical approach on the prognosis of upper urinary tract urothelial carcinoma and provided guidance for clinical treatment.【Methods】 This study collected the clinical and pathological data of patients diagnosed with upper urinary tract urothelial carcinoma from 2005 to 2016 in the Second Hospital of Tianjin Medical University.The statistics of this study include: age of patients,gender,history of bladder cancer,location of tumor,tumor size,tumor number,pathological stage,pathological grade,and surgical methods.This study was divided into groups according to the different surgical methods.One group distinguishes patients on the basis of open or laparoscopy,and the other group distinguishes patients on the basis of whether bladder resection is performed or not.Follow-up includes: urine routine,cystoscopy,urinary ultrasound,and radiograph of chest.The follow-up plan for patients is: every 3 months in 1st year,every 6 months in 2nd and 3rd year,every year thereafter.Patients with local UUT-UC recurrence,postoperative bladder tumors,distant metastases,and patient deaths during follow-up review are considered disease progression.In this study,Kaplan-Meier survival curves were used to compare the prognosis of different groups of patients.We also analyzed the effect of each study parameter on the overall survival rate by using univariate and multivariate Cox regression models.【Results】 1.Univariate analysis showed that patients with upper urinary tract urothelial carcinoma undergoing open surgery or laparoscopic surgery did not differ in overall survival.The Kaplan-Meier survival curve shows that patients receiving these two surgical procedures have no difference in overall survival.The study found that there are correlation factors: stage of pathology(p <0.001),age(p = 0.023),grade of pathology(p <0.001),the infiltration of lymphatic vessels(p = 0.001)and lymph nodes(p = 0.002).In addition,multivariate cox regression analysis showed that the associated factors included age(HR=1.01,95% CI 0.98-1.06,p=0.718),the stage of pathology(HR=2.44,95% CI 1.62-3.48,p=0.004),and grade of pathology(HR=3.12,95%CI 1.66-6.40,p=0.006),infiltration of lymphatic vessels(HR=3.46,95%CI 1.70-8.02,p=0.008)and lymph nodes(HR=1.69,95% CI 0.34-7.20,p=0.579).2.The one-,two-,and five-year overall survival rates of the NUC and NUW groups were 89.6% vs.76.1%,82.7% vs.63.8%,and 68.8% vs.50.7%,respectively.In other words,patients who received combined bladder cuff resection achieved a significant survival benefit.3.There was no statistical correlation between open or laparoscopic surgery(p=0.631),combined bladder cuff resection(p=0.512)and postoperative bladder tumors.Associated with bladder tumors after NU surgery was a history of bladder cancer(p<0.001),multiple tumors(p=0.031),and preoperative hydronephrosis(p=0.005).【Conclusion】 Open or laparoscopic radical nephroureterectomy has no effect on the overall survival of patients.Bladder cuff resection can improve the overall survival of patients.There was no statistical correlation between open or laparoscopic surgery,combined bladder sleeve resection and postoperative bladder tumors.Associated with bladder tumors after NU surgery was a history of bladder cancer,multiple tumors and preoperative hydronephrosis.