Nephroureterectomy for upper tract urothelial carcinoma recurrence in bladder cancer patients treated with radical cystectomy: a multicentric propensity score matched analysis on predictors, practice patterns and survival outcomes.
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Santarelli Valerio, Asero Vincenzo, Corvino Roberta, De Berardinis Ettore, Sciarra Alessandro, Basile Giuseppe, Abu-Ghanem Yasmin, Nair Rajesh, Khan Muhamad Shamin, Thurairaja Ramesh, Krajewski Wojciech, Laszkiewicz Jan, Albisinni Simone, Mori Keiichiro, Guerrero-Ramos Felix, D'Andrea David, Gallioli Andrea, Laukhtina Ekaterina, Grobet-Jeandin Elisabeth, Reynard Maxence, Mari Andrea, Mertens Laura S, Soria Francesco, Teoh Jeremy, Claps Francesco, Amodeo Antonio, Ślusarczyk Aleksander, Contieri Roberto, Perdonà Sisto, Subiela José Daniel, Tully Karl H, Pichler Renate, Antonelli Alessandro, Bertolo Riccardo, Ditonno Francesco, Hurle Rodolfo, Crocetto Felice, Mayr Roman, Porreca Angelo, Marino Filippo, Simone Giuseppe, Tuderti Gabriele, Rocco Bernardo Maria Cesare, Sighinolfi Chiara, Vittori Luigi, Moschini Marco, Zaurito Paolo, De Angelis Mario, Scillipoti Pietro, Afferi Luca, De Groote Ruben, De Naeyer Geert, Mottrie Alexandre, Pavan Nicola, Chung Benjamin I, Marcq Gautier, Pradere Benjamin, Del Giudice Francesco, European Association of Urology -Young Academic Urologists (EAU -YAU), Urothelial Carcinoma Working Group
Аннотация
METHODS: Patients undergoing RNU for metachronous UTUC were extracted from a multi-institutional RC database. A 1:2 Propensity Score Match (PSM) was performed based on age, gender, BMI, CCI, Smoking Status, and cT stage between RC only and RC + RNU patients. Simon-Makuch plots, landmark analyses and Multivariable Cox regressions were adopted to compare survival outcomes.
RESULTS: Of 1804 RC patients, 85 (4.7%) underwent subsequent RNU. At multivariate regression, younger age, smoking history, BCG exposure, NMIBC, CIS and positive ureteric margins were identified as positive predictors of upper tract recurrence. After PSM, 81 RC + RNU patients were matched to 157 RC only controls. Median time from RC to RNU was 29 (18-47) months, with the majority of UTUC diagnosed at a muscle-invasive stage (70.9%). Simon-Makuch curves demonstrated worse Cancer Specific Survival (CSS) of the RC + RNU cohort (HR: 6.41, 95% CI 3.16-13.04). At landmark analyses, RNU was consistently associated with an increased mortality risk from the 24th month onward. Multivariable Cox regression identified RNU and pN + as the only significant predictors of worse CSS (respectively, HR: 6.55, 95% CI 2.93-14.64 and HR: 8.45, 95% CI 3.24-21.99).
CONCLUSIONS: The worse survival outcomes and high rates of locally advanced disease found at RNU underscore the need for standardized, risk-stratified, long-term follow-up of the remnant urinary tract following RC.