Decisional and prognostic impact of diagnostic ureteroscopy in high-risk upper tract urothelial carcinoma: A multi-institutional collaborative analysis (ROBUUST collaborative group)
Recommended Citation
Ditonno F, Franco A, Veccia A, Bertolo R, Wu Z, Wang L, Abdollah F, Finati M, Simone G, Tuderti G, Helstrom E, Correa A, De Cobelli O, Ferro M, Porpiglia F, Amparore D, Tufano A, Perdonà S, Bhanvadia R, Margulis V, Brönimann S, Singla N, Puri D, Derweesh IH, Mendiola DF, Gonzalgo ML, Ben-David R, Mehrazin R, Moon SC, Rais-Bahrami S, Yong C, Sundaram CP, Moghaddam FS, Ghoreifi A, Djaladat H, Autorino R, and Antonelli A. Decisional and prognostic impact of diagnostic ureteroscopy in high-risk upper tract urothelial carcinoma: A multi-institutional collaborative analysis (ROBUUST collaborative group). Urol Oncol 2024.
Document Type
Article
Publication Date
9-1-2024
Publication Title
Urologic oncology
Abstract
BACKGROUND: Diagnostic ureteroscopy (URS) with or without biopsy remains a subject of contention in the management of upper tract urothelial carcinoma (UTUC), with varying recommendations across different guidelines. The study aims to analyse the decision-making and prognostic role of diagnostic ureteroscopy (URS) in high-risk UTUC patients undergoing curative surgery.
MATERIALS AND METHODS: In this retrospective multi-institutional analysis of high-risk UTUC patients from the ROBUUST dataset, a comparison between patients who received or not preoperative URS and biopsy before curative surgery was carried out. Logistic regression analysis evaluated differences between patients receiving URS and its impact on treatment strategy. Survival analysis included 5-year recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS). After adjusting for high-risk prognostic group features, Cox proportional hazard model estimated significant predictors of time-to-event outcomes.
RESULTS: Overall, 1,912 patients were included, 1,035 with preoperative URS and biopsy and 877 without. Median follow-up: 24 months. Robot-assisted radical nephroureterectomy was the most common procedure (55.1%), in both subgroups. The 5-year OS (P = 0.04) and CSS (P < 0.001) were significantly higher for patients undergoing URS. The 5-year RFS (P = 0.6), and MFS (P = 0.3) were comparable between the 2 groups. Preoperative URS and biopsy were neither a significant predictor of worse oncological outcomes nor of a specific treatment modality.
CONCLUSIONS: The advantage in terms of OS and CSS in patients undergoing preoperative URS could derive from a better selection of candidates for curative treatment. The treatment strategy is likely more influenced by tumor features than by URS findings.
Medical Subject Headings
Humans; Ureteroscopy; Male; Female; Retrospective Studies; Prognosis; Aged; Carcinoma, Transitional Cell; Ureteral Neoplasms; Middle Aged; Clinical Decision-Making; Kidney Neoplasms
PubMed ID
38760274
ePublication
ePub ahead of print
Volume
42
Issue
9
First Page
1
Last Page
290
