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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (5): 961-966. doi: 10.19723/j.issn.1671-167X.2025.05.022

• 论著 • 上一篇    下一篇

腹腔镜下膀胱癌根治术同期行肾输尿管全长切除术的预后分析

李慎谟1,2,*, 苏丹丹1,*, 林己煜1,3, 宋昊东1,3, 马潞林1, 侯小飞1, 王国良1, 张洪宪1, 叶剑飞1,*(), 张树栋1,*()   

  1. 1. 北京大学第三医院泌尿外科, 北京 100191
    2. 郑州人民医院泌尿外科, 郑州 450002
    3. 北京大学基础医学院临床医学专业, 北京 100191
  • 收稿日期:2024-11-21 出版日期:2025-10-18 发布日期:2025-05-07
  • 通讯作者: 叶剑飞, 张树栋
  • 作者简介:* These authors contributed equally to this work
  • 基金资助:
    北京市自然科学基金(Z230014); 北京大学第三医院临床重点项目(BYSYFY2021046); 和北京市希思科临床肿瘤学研究基金会项目(Y-tongshu2021/ms-0072)

Prognostic analysis of laparoscopic simultaneous radical cystectomy and nephroureterectomy

Shenmo LI1,2, Dandan SU1, Jiyu LIN1,3, Haodong SONG1,3, Lulin MA1, Xiaofei HOU1, Guoliang WANG1, Hongxian ZHANG1, Jianfei YE1,*(), Shudong ZHANG1,*()   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Urology, Zhengzhou People's Hospital, Zhengzhou 450002, China
    3. Department of Clinical Medicine, Peking University School of Basic Medical Sciences, Beijing 100191, China
  • Received:2024-11-21 Online:2025-10-18 Published:2025-05-07
  • Contact: Jianfei YE, Shudong ZHANG
  • Supported by:
    the Beijing Natural Science Foundation(Z230014); the Key Clinical Projects of Peking University Third Hospital(BYSYFY2021046); CSCO Clinical Oncology Research Foundation of Beijing(Y-tongshu2021/ms-0072)

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摘要： 目的: 探讨腹腔镜下膀胱癌根治术同期行单侧肾输尿管全长切除术(radical cystectomy and nephrourete-rectomy, RCNU)治疗上尿路尿路上皮癌合并膀胱癌的安全性及预后影响因素。方法: 回顾性分析2009年1月至2023年9月, 北京大学第三医院收治并行腹腔镜下RCNU手术患者的临床资料。根据相同性别、年龄(±5岁)、既往尿路上皮肿瘤病史、基础疾病、T分期、N分期、M分期、美国麻醉医师协会(American Society of Anesthesiologists, ASA)评分、Charlson合并症指数和体重指数(body mass index, BMI)(±5)等指标情况, 将34例RCNU患者与单独接受腹腔镜下膀胱癌根治术(radical cystectomy, RC)的膀胱癌患者进行1 ∶1人工匹配。采用Kaplan-Meier生存分析法计算患者的生存率, 应用Cox比例回归风险模型分析影响预后的临床因素。结果: 组的68例患者中, 随访率100%, 中位随访时间27.0(11.7, 60.2)个月。两组患者术中情况(包括手术时间、术中估计出血量、术中输血量等)的对比差异均无统计学意义(P>0.05)。两组患者术前肌酐和术后肌酐的差异均有统计学意义(P < 0.05)。RC组围术期Clavien Ⅲ~Ⅳ级并发症的发生率为2.9%(1/34), RCNU组为5.9%(2/34), 两组患者的围术期并发症发生率差异无统计学意义。与单独接受RC的匹配组相比, 接受RCNU的患者总生存期显著降低(P < 0.05)。Cox回归分析提示, N分期高、术后肌酐高这两个因素是影响患者预后的独立危险因素(P < 0.05)。结论: 同期行单侧RCNU手术与单纯行腹腔镜下RC手术的患者相比, 手术时间、术中出血量以及围术期并发症等方面临床上未见显著差异, 但术前肾功能和术后肾功能的差异均有统计学意义, RCNU手术患者比单纯RC手术患者的生存预后更差。

关键词: 上尿路尿路上皮癌, 膀胱癌, 根治性膀胱切除术, 肾输尿管切除术, 存活率分析

Abstract: Objective: To investigate the safety and prognostic factors influencing the treatment of upper urinary tract urothelial carcinoma (UTUC) combined with bladder cancer (BCa) by laparoscopic simultaneous radical cystectomy and nephroureterectomy (RCNU). Methods: The clinical data of patients admitted to Peking University Third Hospital for laparoscopic RCNU surgery from January 2009 to September 2023 were analyzed retrospectively. Based on the same gender, age (±5 years), history of uroepithelial tumors, underlying diseases, T-stage, N-stage, M-stage, American Society of Anesthesiologists (ASA) score, Charlson comorbidity index, and body mass index (BMI) (±5), 34 patients with RCNU were matched 1 ∶1 with patients with bladder cancer who underwent laparoscopic radical cystectomy (RC) alone. Kaplan-Meier survival analysis was used to calculate patient survival, and Cox proportional regression risk model was used to analyze clinical factors affecting prognosis. Results: Of the 68 patients enrolled, the follow-up rate was 100% with a median follow-up time of 27.0 (11.7, 60.2) months. Comparison of intraoperative conditions (including operation time, estimated intraoperative bleeding, intra-operative blood transfusion, etc.) between the two groups of patients showed no significant difference (P>0.05). Comparison of preoperative creatinine and postoperative creatinine between the two groups of patients showed significant differences (P < 0.05). The perioperative Clavien grade Ⅲ-Ⅳ complication rates were 2.9% (1/34) in the RC group and 5.9% (2/34) in the RCNU group. There was no significant difference in terms of perioperative complications between the two groups. Overall survival was significantly lower in the patients receiving RCNU compared with the matched group receiving RC alone (P < 0.05). Cox regression analysis suggested that two factors, high N stage and high postoperative creatinine, were independent risk factors affecting the prognosis of patients in the 2 groups (P < 0.05). Conclusion: The overall survival prognosis of patients undergoing RCNU surgery was worse compared with laparoscopic RC surgery alone during the same period. There was no clinically significant difference between the two groups in terms of operation time, intraoperative bleeding, and perioperative complications, and there were clinically significant differences in preoperative renal function and post-operative renal function.

Key words: Upper urinary tract uroepithelial carcinoma, Bladder cancer, Radical cystectomy, Nephroureterectomy, Survival analysis

中图分类号: 

  • R737.1

表1

两组患者匹配的变量对比"

Items RC alone (n=34) RCNU (n=34) All patients (n=68) P value
Ages at surgery/years, ${\bar x}$±s 69.21±9.41 69.94±9.30 69.57±9.29 0.657
Gender, n (%) >0.999
  Female 11 (32.4) 11 (32.4) 22 (32.4)
  Male 23 (67.6) 23 (67.6) 46 (67.6)
BMI/(kg/m2), ${\bar x}$±s 23.86±2.56 23.41±3.84 23.64±3.25 0.518
CCI, n (%) 0.624
   < 2 16 (47.1) 13 (38.2) 29 (42.7)
  ≥2 18 (52.9) 21 (61.8) 39 (57.3)
pT stage, n (%) 0.401
   < pT2 10 (29.4) 7 (20.6) 17 (25.0)
  ≥pT2 24 (70.6) 27 (79.4) 51 (75.0)
pN stage, n (%) 0.525
  N0/X 27 (79.4) 29 (85.3) 56 (82.4)
  N1 7 (20.6) 5 (14.7) 12 (17.6)
Tumor grade, n (%) 0.317
  G1 1 (2.9) 0 (0) 1 (1.5)
  G2 1 (2.9) 1 (2.9) 2 (2.9)
  G3 32 (94.2) 33 (97.1) 65 (95.6)
ASA score, n (%) 0.287
  <3 27 (87.1) 23 (67.6) 50 (76.9)
  ≥3 4 (12.9) 11 (32.4) 15 (23.1)
TURBT history, n (%) >0.999
  No 11 (32.4) 11 (32.4) 22 (32.4)
  Yes 23 (67.6) 23 (67.6) 46 (67.6)
Fundamental disease, n (%) 0.805
  HBP 18 (52.9) 16 (47.1) 34 (50) 0.634
  DM 7 (20.6) 6 (17.6) 13 (19.1) 0.763
  Coronary heart disease 6 (17.6) 5 (14.7) 11 (16.2) 0.705
Smoking, n (%) 8 (23.5) 6 (17.6) 14 (19.1) 0.564

表2

两组患者围术期情况及术后并发症对比"

Items RC alone (n=34) RCNU (n=34) All patients P value
Length of hospital stay/d, M (P25, P75) 12 (8, 18) 12 (8, 16) 12 (8, 16) 0.379
Operation time/min, ${\bar x}$±s 403.0±36.2 465.3±66.3 429.9±32.2 0.107
Estimated blood loss/mL, M (P25, P75) 200 (150, 400) 200 (100, 400) 200 (150, 400) 0.923
Clavien complications, n (%) 0.746
  Clavien Ⅰ 19 (55.9) 18 (52.9) 37 (54.4)
  Clavien Ⅱ 14 (41.2) 14 (41.2) 28 (41.2)
  Clavien Ⅲ-Ⅴ 1 (2.9) 2 (5.9) 3 (4.4)
Preoperative albumin, g/L, ${\bar x}$ ±s 40.52±1.72 38.73±1.99 40.30±1.21 0.150
Postoperative albumin, g/L, ${\bar x}$ ±s 31.09±1.97 30.37±1.78 30.64±1.34 0.665
Preoperative creatinine/(μmol/L), M (P25, P75) 87.00 (66.75, 113.00) 118.50 (86.25, 208.50) 95.50 (74.50, 140.75) 0.004*
Postoperative creatinine/(μmol/L), M (P25, P75) 81.00 (63.75, 104.25) 125.00 (88.75, 242.25) 101.50 (68.25, 139.75) 0.001*
Creatinine difference/(μmol/L), ${\bar x}$ ±s 2.49±17.79 12.46±17.28 7.47±12.13 0.430
NLR, n (%) 0.329
  ≤4.00 17 (50.0) 21 (61.8) 38 (55.9)
  >4.00 17 (50.0) 13 (38.2) 30 (44.1)

图1

两组患者的OS曲线"

表3

影响患者预后的单因素分析和多因素分析"

Characteristics Univariate Multivariate
HR 95%CI P HR 95%CI P
Surgery type
  RC Ref.
  RCNU 2.042 1.029-4.053 0.037* 1.043 0.439-2.097 0.960
Age at surgery 1.686 0.801-3.301 0.122
Gender
  Male Ref.
  Female 1.082 0.520-2.253 0.833
BMI 1.014 0.913-1.126 0.798
CCI
   < 2 Ref.
  ≥2 1.577 0.801-3.105 0.184
ASA score
   < 3 Ref.
  ≥3 2.379 1.227-4.614 0.008* 0.976 0.332-2.873 0.965
Fundamental disease
  ≤1 Ref.
  >2 1.294 0.672-2.494 0.441
Previous tumor history
  No Ref.
  Yes 0.660 0.309-1.411 0.269
pT stage (MIBC/NMIBC)
  ≤pT1 Ref. Ref.
  >pT1 2.425 1.006-5.845 0.031* 1.422 0.552-3.660 0.466
pN stage
  ≤N0 Ref. Ref.
  >N0 3.545 1.687-7.449 0.003* 6.889 2.652-17.895 < 0.001*
NLR
  ≤4.00 Ref.
  >4.00 1.479 0.766-2.856 0.243
Number of complications 1.037 0.956-1.125 0.437
Postoperative hospital stay 0.976 0.942-1.010 0.124
Operation time 0.998 0.993-1.003 0.403
Estimated blood loss 1.001 0.999-1.002 0.541
Preoperative albumin 0.416 0.204-0.851 0.013* 0.509 0.211-1.230 0.134
Postoperative albumin 1.357 0.612-3.009 0.456
Preoperative creatinine 2.718 1.406-5.255 0.002*
Postoperative creatinine 3.049 1.566-5.936 0.001* 4.326 1.370-13.656 0.013*
Pelvic lymph node dissection 1.611 0.701-3.699 0.261
1
Rouprêt M , Seisen T , Birtle AJ , et al. European Association of Urology guidelines on upper urinary tract urothelial carcinoma: 2023 update[J]. Eur Urol, 2023, 84 (1): 49- 64.

doi: 10.1016/j.eururo.2023.03.013
2
Wang Q , Zhang T , Wu J , et al. Prognosis and risk factors of patients with upper urinary tract urothelial carcinoma and postoperative recurrence of bladder cancer in Central China[J]. BMC Urol, 2019, 19 (1): 24.

doi: 10.1186/s12894-019-0457-5
3
Fang D , Zhang L , Li X , et al. Risk factors and treatment outcomes of new contralateral upper urinary urothelial carcinoma after nephroureterectomy: The experiences of a large Chinese center[J]. J Cancer Res Clin Oncol, 2014, 140 (3): 477- 485.

doi: 10.1007/s00432-014-1585-7
4
Fang D , Liu P , Li X , et al. Characteristics and treatment outcomes of pan-urothelial cell carcinoma: A descriptive analysis of 45 patients[J]. Sci Rep, 2015, 5, 18014.

doi: 10.1038/srep18014
5
Aumatell J , Huguet J , Subiela JD , et al. Endoscopic exploration directly impacts clinical decision making in the management of patients with suspected upper tract urothelial carcinoma following radical cystectomy[J]. Urol Oncol, 2021, 39 (10): 732. e1- 732. e8.

doi: 10.1016/j.urolonc.2021.03.002
6
Britton CJ , Gottlich HC , Tarrell RF , et al. Perioperative and oncologic outcomes associated with simultaneous radical cystectomy and nephroureterectomy[J]. Urology, 2023, 172, 149- 156.

doi: 10.1016/j.urology.2022.09.039
7
Kamei J , Fujisaki A , Saito K , et al. Less invasive and equivalent short-term outcomes with simultaneous en bloc robot-assisted radical cystectomy and laparoscopic nephroureterectomy: Comparison with conventional open radical cystectomy and nephroureterectomy[J]. Asian J Endosc Surg, 2022, 15 (2): 255- 260.

doi: 10.1111/ases.12989
8
Novara G , Catto JWF , Wilson T , et al. Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy[J]. Eur Urol, 2015, 67 (3): 376- 401.

doi: 10.1016/j.eururo.2014.12.007
9
Parekh DJ , Reis IM , Castle EP , et al. Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): An open-label, randomised, phase 3, non-inferiority trial[J]. Lancet, 2018, 391 (10139): 2525- 2536.

doi: 10.1016/S0140-6736(18)30996-6
10
Buse S , Alexandrov A , Mazzone E , et al. Surgical benchmarks, mid-term oncological outcomes, and impact of surgical team composition on simultaneous enbloc robot-assisted radical cystectomy and nephroureterectomy[J]. BMC Urol, 2021, 21 (1): 73.

doi: 10.1186/s12894-021-00839-y
11
Subiela JD , González-Padilla DA , Huguet J , et al. Oncological and renal function outcomes in patients who underwent simulta-neous radical cystectomy and nephroureterectomy for synchronous or metachronous panurothelial carcinoma[J]. Urology, 2023, 172, 157- 164.

doi: 10.1016/j.urology.2022.08.064
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ISSN 1671-167X
CN 11-4691/R
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