| ObjectiveThrough the comparison of the clinical curative effect and the prognosis of Low Grade(G1、G2), Low Stage(PTa/Tis、PT1、PT2) primary ureteral cancer patients who underwent radical nephroureterectomy(RNU) with bladder cuff excision and nephron-sparing measures(NSM), to explore the clinical value of NSM for low grade, low stage primary ureteral cancer patients.MethodsRetrospective analysis of 79 clinical cases of low grade and low Stage primary ureteral cancer patients of Anhui Provincial Hospital from January 1, 2000 to January 1, 2013. There were 51 cases of male patients and 28 cases of female patients, age ranged from 45 to 81(63.22 + 9.85), median age was 63 years old. The first symptom of 59 cases were hematuria, 15 cases of patients were asymptomatic. Patients accepted reasonably B ultrasound, IVU, retrograde pyelography, CT, MRI, urine cytology, cystoscopy, ureteroscopy and biopsy before operation. According to the mode of operation, they were divided into RNU with bladder cuff excision(group A,54cases) and NSM(group B, 25cases). All patients underwent intravesical chemotherapy after operation. By using two independent sample t test and chi-square test to compare two groups of patients’ age, sex, tumor site(the upper, middle, lower ureter segment),tumor number(single, multiple), tumor grade and tumor stage differences. Analyzing the 5 year recurrence-free survival(RFS), metastasis-free survival(MFS) and cancer-specific survival(CSS) by Kaplan-Meier survival analysis and Log-rank test was used to compare differences.ResultsIn 79 patients, 45 cases were diagnosed by B ultrasound(45/72, 62.5%), 37 cases were diagnosed by IVU(37/50, 74%), 10 cases were diagnosed by(10/12, 83.3%), 57 cases were diagnosed by CT(57/63, 90.5%), 19 cases were diagnosed by MRI(19/20, 95%), 11 cases were diagnosed by urinary cytology(11/35, 31.4%), 12 cases were diagnosed by ureteroscopic examination and biopsy(12/12, 100%). 9 cases of patients were located in the upper ureter(11.4%), 23 cases of patients were located in the middle segment(29.1%), 47 cases of patients were located in the lower segment(59.5%). Operations were performed successfully in both groups, postoperative pathological findings confirmed the diagnosis of transitional cell carcinoma. Patients of group A with tumor stage was PTa/Tis 19 cases, PT1 20 cases, PT2 15 cases, tumor grade was G1 15 cases,G2 39 cases. patients of group B with tumor stage was PTa/Tis 11 cases, PT1 8 cases, PT2 6 cases, tumor grade was G1 8cases, G2 17 cases.71cases(81.9%) were followed up for 6~120months. There were no statistical difference between the group A and group B for age(t=0.700, P=0.486), gender(χ2=0.332, P=0.565), tumor stage(χ2=0.564, P=0.754) and grade(χ2=0.148, P=0.701), tumor number(χ2=0.673, P=0.412), tumor location(χ2=0.476, P=0.788), two groups of patients with postoperative 5 year RFS rates were 70.9% and 66.8%, 5 year MFS rates were 80.2% and 77.1%, 5 years of CSS rates were 86.3% and 82.2%, there were no statistically significant difference(P>0.05).ConclusionNSM was comparable to RNU with bladder cuff excision for the management of Low Grade, Low Stage primary ureteral cancer with similar effect of clinical curative effect and prognosis. Therefore, using small trauma to NSM on low level, low stage primary ureteral cancer has good clinical application value. |
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