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Updated: Feb 12, 2026

Generation of Comprehensive Thoracic Oncology Database - Tool for Translational Research

Generation of Comprehensive Thoracic Oncology Database - Tool for Translational Research

Published on: January 22, 2011

膀胱癌手術：根治的膀胱全摘除術と同時腎尿管全摘除術は再発率が高いが、生存率に影響はない。監視下で腫瘍学的に安全。

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

要旨

Background:

Oncological safety and prognostic implications of concurrent nephroureterectomy (RNU) performed during radical cystectomy (RCx) for bladder cancer remain controversial due to potential selection bias in previous studies.

Objectives:

To evaluate oncological outcomes of concurrent RNU during RCx using propensity score matching (PSM) and multivariable Cox regression to minimize selection bias and identify independent prognostic factors.

Materials And Methods:

We analyzed 2944 patients who underwent RCx from a Korean multicenter database (2000-2022). Patients were stratified into RCx only (n = 2627) and concurrent RCx + RNU (n = 317) groups. PSM was performed using age, sex, BMI, ASA score, and clinical TNM stage, creating 284 matched pairs. Multivariable Cox proportional hazards regression was performed adjusting for demographic, clinical, and pathologic variables. Primary outcomes were recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS).

Results:

After PSM, recurrence remained significantly higher in RCx + RNU (60.4% vs 40.9%, p < 0.001), with 5-year RFS of 32.8% vs 51.6% (p = 0.0005). However, CSS (68.4% vs 71.6%, p = 0.408) and OS (52.9% vs 55.4%, p = 0.830) at 5 years showed no significant differences. Multivariable Cox regression confirmed that concurrent RNU was not an independent prognostic factor (RFS: HR 1.38, p = 0.106; CSS: HR 1.27, p = 0.223; OS: HR 1.11, p = 0.443). Independent adverse prognostic factors included pathologic N+ disease (CSS: HR 2.69, p < 0.001; OS: HR 1.88, p < 0.001), lymphovascular invasion (RFS: HR 1.81, p = 0.014; CSS: HR 1.92, p = 0.002; OS: HR 1.67, p = 0.002), and ASA score ≥3 (RFS: HR 1.85, p = 0.002).

Conclusion:

Concurrent RNU during RCx is associated with higher recurrence rates but does not compromise cancer-specific or overall survival and is not an independent prognostic factor after adjusting for pathologic characteristics. The higher recurrence reflects more aggressive underlying disease biology rather than adverse surgical effects. One-stage concurrent RNU is oncologically safe in appropriately selected patients but necessitates intensive surveillance.

キーワード:

膀胱癌コックス比例ハザードモデル腎尿管全摘除術予後傾向スコアマッチング根治的膀胱全摘除術生存

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