| الوصف: |
Introduction The gold standard treatment for upper tract urothelial carcinomas (UTUC) is radical nephroureterectomy with bladder-cuff excision. However, the role of combination of ureterorenoscopy and laser ablation has recently become more essential. This study aimed to investigate the efficacy of Thulium laser ablation of UTUC and estimate clinical outcomes with subgroup analyses. Methods After obtaining informed consent, we retrospectively reviewed all patients who had undergone endoscopic Thulium laser ablation of UTUC as their primary treatment from Jun 2012, to Nov 2018. Sixty-eight patient were enrolled, and thirty-four patients were analyzed after selection by exclusion criteria. Comparisons with bivariate analyses between patients with and without recurrence were examined. Multivariable cox regression model were further applied. Further, Kaplan-Meier survival estimate were presented with comparison of the survival curves, we also combined two of three tumor characteristics (stage, size, and grade of tumor) for subgroup analyses. Results Fifteen patients (44%) had local tumor recurrence. Seven patients (21%) had recurrence at the urinary bladder. Two patients (6%) had lymph node or distal metastasis. A total of 4 patients (12%) had cancer-specific death. In bivariate analyses, statistical significance is noted for age, tumor grade and tumor size with p-values of 0.018, 0.047 and 0.014, respectively. In the multivariable analysis, statistical significance is noted for age and tumor size with p-values of 0.017, and 0.042, respectively. In Kaplan–Meier estimate for subgroup analysis, statistical significance is only noted in the tumor size + tumor grade group but almost achieved in the tumor size + biopsy stage group with p-value of 0.0275 and 0.0518, respectively. Conclusion In our experience, tumor size and tumor grade are influential recurrence factors. However, biopsy stage does not achieve statistical significance in both the recurrence analysis and survival estimate. In the subgroup analyses, tumor size is a more influential factor than tumor grade in the prognosis of local recurrence. |
