Real-world multicenter adherence to international guidelines in the management of upper tract urothelial carcinoma: insights from the ROBUUST 2.0 Registry.
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Ferriero Mariaconsiglia, Tuderti Gabriele, Proietti Flavia, Chiacchio Giuseppe, Bignante Gabriele, Wu Zhenjie, Wang Linhui, Margulis Vitaly, Bhanvadia Raj, Abdollah Firas, Cusumano Nicholas B, Antonelli Alessandro, Ditonno Francesco, Veccia Alessandro, Singla Nirmish, Brönimann Stephan, Derweesh Ithaar H, Puri Dhruv, Meagher Margaret F, Rais-Bahrami Soroush, Moon Sol C, Ferro Matteo, DE Cobelli Ottavio, Porpiglia Francesco, Amparore Daniele, Checcucci Enrico, Lee Randall, Correa Andres F, Eun Daniel D, Gonzalgo Mark L, Nativ Omri F, Perdonà Sisto, Tufano Antonio, Eraky Ahmed, Mehrazin Reza, Yong Courtney, Sundaram Chandru P, Yoshida Takashi, Kinoshita Hidefumi, Ghoreifi Alireza, Moghaddam Farshad S, Djaladat Hooman, Autorino Riccardo, Simone Giuseppe
Аннотация
METHODS: A multicenter retrospective analysis from the ROBUUST (ROBotic surgery for Upper tract Urothelial cancer STudy) registry was performed to assess the region-specific adherence rates to guidelines (GL) for perioperative treatments and their impact on oncological outcomes was evaluated with the Kaplan-Meier method.
RESULTS: Out of 2307 patients, excision was the most adopted approach for bladder cuff management world-wide (USA 88.6%, EU 90.5%, Asia 89.8%). Postoperative bladder instillation (intravesical chemotherapy) was implemented in 28.4% of all cases and did not impact bladder recurrence-free survival (log rank P=0.45). Lymphadenectomy (LND) in high-risk disease was underused in both locally advanced (cT3-4: USA 35.8%, EU 46.8%, A 25%) and cN+ stages (USA 41.9%, EU 47.9%, A 43%). LND was not associated with better cancer-specific survival (CSS) across all stages (log rank P≥0.53). Adjuvant chemotherapy (AdCHT) was administered overall in 27.8% of pT2-T4 cases, with a significantly higher adoption in Asia (P=0.03); while in pN+ disease, AdCHT rate was 30.2% and did not convey any advantage in CSS (P=0.58). Retrospective design is the main limitation of the present study.
CONCLUSIONS: The present contemporary "real world" data suggests poor adherence to current EAU-AUA guidelines for key indicators of quality care such as perioperative bladder instillation of chemotherapy, performance of LND and administration of adjuvant chemotherapy for advanced disease. These findings highlight the need of improving the implementation of these guideline driven treatment strategies.