Cancer Res Treat.  2019 Jul;51(3):963-972. 10.4143/crt.2018.465.

Laparoscopy versus Open Nephroureterectomy in Prognostic Outcome of Patients with Advanced Upper Tract Urothelial Cancer: A Retrospective, Multicenter, Propensity-Score Matching Analysis

• Kim SH
• Song MK
• Kim JK
• Hong B
• Kang SH
• Ku JH
• Jeong BC
• Seo HK
• Urothelial Cancer-Advanced Research and Treatment (UCART) Study Group

• KMID: 2454288
• DOI: http://doi.org/10.4143/crt.2018.465

Abstract

PURPOSE
The purpose of this study was to compare oncologic outcomes between open nephroureterectomy (ONU) and laparoscopic nephroureterectomy (LNU) in patients with upper tract urothelial carcinoma.
MATERIALS AND METHODS
The medical records of consecutive ONU and LNU cases from five tertiary institutions were retrospectively analyzed between 2000 and 2012. The propensity-score matching methodology was used to compare the two surgical approaches in terms of age, body mass index, American Society of Anesthesiologists score, tumor location, grade, pathologic T and N categories, the presence of lymphovascular invasion, and follow-up duration. The Kaplan-Meier with log-rank tests and clustered Cox regression were used to compare the estimated rates of survival for each surgical approach and to investigate the effect of the surgical approach on each prognostic outcome.
RESULTS
Six hundred thirty-eight propensity-score matching pairs (n=1,276) were compared; LNU was significantly better than ONU in all types of survival, including intravesical recurrence-free survival (IVRFS), disease-free survival, overall survival (OS), and cancer-specific survival (CSS) (p < 0.05). The 3-year OS and CSS rates were significantly higher with LNU than with ONU (p < 0.05). Compared with ONU, LNU had significantly better 3-year OS and CSS rates (82.9% and 86.2% vs. 78.3% and 81.8%); there were no differences at 5 years. In subgroup analysis of the early-staged group, advanced-stage group, lymph node-positive group, and lymph node-negative group, the two approaches did not significantly affect prognostic outcomes, except LNU improved the IVRFS in the lymph node-negative or no history of previous bladder cancer group.
CONCLUSION
LNU had a significantly better prognostic outcome than ONU after propensity-score matching.

Keyword

Urothelial carcinoma; Laparoscopy; Nephroureterectomy; Prognosis; Survival

MeSH Terms

Body Mass Index
Disease-Free Survival
Follow-Up Studies
Humans
Laparoscopy*
Medical Records
Prognosis
Retrospective Studies*
Urinary Bladder Neoplasms

Reference

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