BJU Int. 2021 Nov 2. doi: 10.1111/bju.15627. Online ahead of print.
ABSTRACT
OBJECTIVE: Evaluate long-term oncologic outcomes of patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU) and the impact of diagnostic ureteroscopy (URS) on survival outcomes.
MATERIALS AND METHODS: A retrospective analysis of all consecutive patients undergoing RNU for suspected UTUC at a UK tertiary referral centre from a prospectively maintained database. The primary outcome measures were 5 and 10 years CSS. The secondary outcomes were: Overall Survival (OS), Recurrence Free Survival (RFS), impact of prior diagnostic URS on OS, CSS and intra-vesical Recurrence Free Survival (IV-RFS) and predictors of intra-vesical recurrence. Statistical analysis was performed in R using the ‘survminer’ and ‘survival’ packages. The Kaplan-Meier method was used to calculate survival functions and expressed in graphical form. Uni-/multivariate survival analyses were performed using the Cox proportional hazard regression model. Statistical significance in this study was set as P < 0.05 RESULTS: 422 patients underwent RNU with confirmed UTUC. The median follow-up of patients with confirmed UTUC was 9.2 (IQR:5.6yrs-12.7 yrs). The 5- and 10-year Cancer Specific survival was 70.5% [95%CI:65.9%-74.9%] and 67.1% [95%CI:62.4%-71.6%] respectively. OS and CSS were similar in diagnostic URS cohort and direct RNU cohort (OS; HR [95% CI] 1.04 [0.78-1.38]; p-0.46), (CSS; HR [95% CI] 0.96 [0.68-1.34]; p-0.81). IV-RFS was superior for the direct RNU cohort [95% CI] 1.94, [1.19-3.17]; p-0.008. On a multivariate analysis Prior URS, T2 stage, proximal ureter tumours and a prior bladder cancer history were predictors of metachronous bladder recurrence CONCLUSION: This single centre retrospective cohort study reports long-term oncological outcomes of RNU with a median follow up of 9.2 years, serving as a reference standard in counselling patients following an RNU. Stage and grade of the NU specimen were the only 2 studied factors that appeared to adversely impact long-term CSS and OS. Our results suggest that the risk of intravesical recurrence is increased nearly two-fold in patients who have had a diagnostic URS prior to RNU. Prior URS however does not appear to adversely impact long term CSS and OS. The authors would suggest that a risk-stratified approach be adopted, wherein diagnostic URS are offered only in equivocal cases.
PMID:34726325 | DOI:10.1111/bju.15627
