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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (5): 961-966. doi: 10.19723/j.issn.1671-167X.2025.05.022

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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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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

CLC Number: 

  • R737.1

Table 1

Comparison of matching variables between the two groups of patients"

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

Table 2

Comparison of perioperative conditions and postoperative complications between the two groups"

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)

Figure 1

OS curves of two groups of patients RC, radical cystectomy; RCNU, radical cystectomy and nephroureterectomy; OS, ovall survival."

Table 3

Univariate analysis and multivariate analysis of the influence on prognosis of two groups of patients"

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
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