Abstract
INTRODUCTION AND OBJECTIVE:
The gold standard treatment for upper urinary tract urothelial carcinoma (UTUC) is by radical nephroureterectomy (RNU). Criteria to qualify for kidney sparing surgery (KSS) have become less strict in consecutive guidelines, thereby gaining a more prominent position. In this study we compare the oncological outcomes and renal function in patients with UTUC treated by KSS and RNU in a tertiary referral center.
METHODS:
In this retrospective cohort study, we included 174 adult patients with histopathological confirmed non-metastatic UTUC from 2010 through 2020 treated with either RNU or KSS (segmental ureter resection, ureterorenoscopy, percutaneous tumor resection). Risk stratification was based on the current EAU guidelines for UTUC.
RESULTS:
The RNU arm had a larger population (86.2%) of high risk tumors compared to the KSS arm (74.4%; p = 0.030). Recurrence Free Survival (RFS), Metastasis Free Survival (MFS), Overall Survival (OS) and Cancer Specific Survival (CSS) concerning KSS and RNU are presented in figure 1. Within the high risk KSS arm 73.2% did not have an imperative reason for choice of treatment. MFS (p = 0.004), CSS (p = 0.027) and OS (p = 0.033) were all significantly higher in the KSS arm when comparing high risk patients in both treatment groups (figure 2). There were no significant long-term differences in renal function, except for three months and one year after intervention (figure 3).
CONCLUSIONS:
Current guidelines indicate that high risk UTUC is best treated by RNU. In this study we conclude that MFS, CSS and OS are significantly higher in KSS in all tumors as well as in high risk tumors treated outside the scope of current guidelines.
The gold standard treatment for upper urinary tract urothelial carcinoma (UTUC) is by radical nephroureterectomy (RNU). Criteria to qualify for kidney sparing surgery (KSS) have become less strict in consecutive guidelines, thereby gaining a more prominent position. In this study we compare the oncological outcomes and renal function in patients with UTUC treated by KSS and RNU in a tertiary referral center.
METHODS:
In this retrospective cohort study, we included 174 adult patients with histopathological confirmed non-metastatic UTUC from 2010 through 2020 treated with either RNU or KSS (segmental ureter resection, ureterorenoscopy, percutaneous tumor resection). Risk stratification was based on the current EAU guidelines for UTUC.
RESULTS:
The RNU arm had a larger population (86.2%) of high risk tumors compared to the KSS arm (74.4%; p = 0.030). Recurrence Free Survival (RFS), Metastasis Free Survival (MFS), Overall Survival (OS) and Cancer Specific Survival (CSS) concerning KSS and RNU are presented in figure 1. Within the high risk KSS arm 73.2% did not have an imperative reason for choice of treatment. MFS (p = 0.004), CSS (p = 0.027) and OS (p = 0.033) were all significantly higher in the KSS arm when comparing high risk patients in both treatment groups (figure 2). There were no significant long-term differences in renal function, except for three months and one year after intervention (figure 3).
CONCLUSIONS:
Current guidelines indicate that high risk UTUC is best treated by RNU. In this study we conclude that MFS, CSS and OS are significantly higher in KSS in all tumors as well as in high risk tumors treated outside the scope of current guidelines.
| Original language | English |
|---|---|
| Title of host publication | ELEVEN YEARS OF EXPERIENCE WITH UPPER TRACT UROTHELIAL CARCINOMA: SURVIVAL AND RENAL FUNCTION AFTER KIDNEY SPARING SURGERY VERSUS RADICAL NEPHROURETERECTOMY |
| DOIs | |
| Publication status | Published - 1 Sept 2021 |