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Resultados oncológicos de la nefrorrectomía simultánea durante la cistectomía radical: un análisis de propensión con

Sang Hun Song¹, Jong Ho Park², Sangchul Lee¹

¹Department of Urology, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.

Surgical oncology

|February 10, 2026

Resumen

La nefrorrectomía concomitante (RNU) durante la cistectomía radical (RCx) para el cáncer de vejiga aumenta la recurrencia, pero no afecta la supervivencia. Este procedimiento es oncológicamente seguro para pacientes seleccionados que necesitan una estrecha vigilancia.

Área de la Ciencia:

Urología Urología Urología.
Oncología Oncología.
Oncología Quirúrgica Oncología Quirúrgica.

Sus antecedentes:

La seguridad oncológica de combinar la nefrorrectomía radical (RNU) con la cistectomía radical (RCx) para el cáncer de vejiga se debate debido al sesgo potencial de selección del paciente.
Los estudios anteriores carecen de datos sólidos para evaluar definitivamente los riesgos y beneficios de este procedimiento combinado.

Objetivo del estudio:

Para evaluar los resultados oncológicos de RNU concurrente durante RCx.
Para minimizar el sesgo de selección mediante el uso de propensión puntuación de coincidencia (PSM) e identificar factores pronósticos independientes para los pacientes con cáncer de vejiga.

Principales métodos:

Análisis de 2944 pacientes sometidos a RCx de una base de datos multicéntrica coreana (2000-2022).
Estratificación en grupos de solo RCx y RCx + RNU concurrentes.
El emparejamiento del puntaje de propensión (PSM) creó 284 parejas emparejadas.
Análisis de regresión de Cox multivariable ajustado por las variables clave.

Principales resultados:

La RCx + RNU simultánea mostró tasas de recurrencia significativamente más altas (60,4% vs 40,9%), pero no hubo diferencias significativas en la supervivencia específica del cáncer a 5 años (CSS) o en la supervivencia general (OS).
El análisis multivariable indicó que la RNU concurrente no era un factor pronóstico independiente para RFS, CSS u OS.
La enfermedad patológica N +, la invasión linfovascular y la puntuación alta de ASA fueron factores pronósticos adversos independientes.

Conclusiones:

RNU simultánea durante RCx se asocia con una mayor recurrencia, pero no compromete CSS o OS.
El aumento de la recurrencia probablemente refleja una biología de la enfermedad más agresiva, no efectos quirúrgicos adversos.
La RNU concurrente de una etapa es oncológicamente segura en pacientes seleccionados, lo que requiere una vigilancia intensiva.

Palabras clave:

El cáncer de vejiga es un cáncer de vejiga.Regresión de Cox Regresión de Cox.Nefrorreterectomía es una cirugía que consiste en hacerse una nefrorreterectomía.El pronóstico de la prognosis.Comparación de la puntuación de propensión a la propensión.La cistectomía radical es una cistectomía radical.La supervivencia es la supervivencia.

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