Background:

There is currently no consensus on the optimal management of de novo unilateral upper tract urothelial carcinoma (UTUC) in renal transplant recipients. We aimed to compare the surgical and oncological outcomes of simultaneous bilateral radical nephroureterectomy (SBRNU) and unilateral radical nephroureterectomy (URNU) to determine the appropriate surgical method.

Methods:

Patients who developed de novo UTUC after renal transplantation and underwent surgical treatment at our center were included in the study. Outcomes were compared between the SBRNU group (underwent bilateral RNU within 3 months) and the URNU group using the Mann–Whitney U-test for continuous variables, Pearson’s chi-square test for categorical variables, and the log-rank test for survival data.

Results:

A total of 48 patients were identified, including 21 and 27 patients in the SBRNU and URNU groups, respectively. Comparison of perioperative data showed that the SBRNU group had a significantly longer operative time (P < .001) and hospital stay (P = .040) than the URNU group but no statistically significant difference in the blood loss (P = .171) and morbidity rate (P = .798). After a median follow-up of 65 months, the SBRNU group had a significantly longer disease-free survival (P = .009), longer cancer-specific survival (P = .032), marginally longer overall survival (P = .066), and similar intravesical recurrence-free survival (P = .274) than the URNU group.

Conclusions:

Our data suggest that SBRNU contributes to improved survival without significantly compromising the perioperative outcomes compared with URNU. SBRNU can be considered a feasible option for de novo UTUC after renal transplantation in specialized centers. Prospective studies should be conducted to further explore the best treatment options for this group of patients.

中文翻译：

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双侧肾输尿管切除术与单侧肾输尿管切除术治疗肾移植后新上尿路上皮癌：手术和肿瘤学结果的比较

背景：

目前对于肾移植受者的新发单侧上尿路尿路上皮癌 (UTUC)的最佳治疗尚无共识。我们旨在比较同时双侧根治性肾输尿管切除术（SBRNU）和单侧根治性肾输尿管切除术（URNU）的手术和肿瘤学结果，以确定合适的手术方法。

方法：

肾移植后新发 UTUC 并在我们中心接受手术治疗的患者被纳入研究。使用连续变量的 Mann-Whitney U检验、分类变量的 Pearson 卡方检验和生存数据的对数秩检验比较 SBRNU 组（在 3 个月内进行双侧 RNU）和 URNU 组的结果。

结果：

共确定了 48 名患者，其中 SBRNU 组和 URNU 组分别有 21 名和 27 名患者。围手术期数据比较表明，SBRNU 组的手术时间（P  < .001）和住院时间（P  = .040）明显长于 URNU 组，但出血量差异无统计学意义（P  = .171）和发病率 ( P  = .798)。中位随访 65 个月后，SBRNU 组的无病生存期（P  = .009）、癌症特异性生存期（ P = .032） 和总生存期（P  = .066）显着延长, 和类似的膀胱内无复发生存率 ( P = .274) 比 URNU 组。

结论：

我们的数据表明，与 URNU 相比，SBRNU 有助于提高生存率，而不会显着影响围手术期结果。SBRNU 可被认为是专科中心肾移植后从头 UTUC 的可行选择。应进行前瞻性研究以进一步探索该组患者的最佳治疗方案。