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, Veccia A, Montanaro F, Pettenuzzo G, Costantino S, Franco A, Wu Z, Correa A, Margulis V, Djaladat H, Simone G, Derweesh IH, Abdollah F, Nirmish S, Ferro M, Porpiglia F, Checcucci E, Gonzalgo ML, Perdonà S, Mehrazin R, Sundaram CP, Autorino R, Antonelli A. Decisional and prognostic impact of diagnostic ureteroscopy in high-risk upper tract urothelial carcinoma: A multi-institutional collaborative analysis (ROBUUST collaborative group). Eur Urol 2024; 85:S713-S714.
Document Type
Conference Proceeding
Publication Date
3-1-2024
Publication Title
Eur Urol
Abstract
Introduction & Objectives: Current guidelines strongly recommend against the use of diagnostic ureteroscopy (URS) in the diagnostic pathway for upper tract urothelial carcinoma (UTUC). We aimed at analysing the decision-making and prognostic role of diagnostic URS in high-risk patients undergoing radical nephroureterectomy (RNU). Materials & Methods: Data were retrieved from the ROBUUST (ROBotic surgery for Upper Tract Urothelial Cancer Study) multicenter international (2015-2022) dataset. A retrospective comparative analysis was conducted to evaluate the characteristics of high-risk patients who either underwent pre-operative URS and biopsy before RNU or did not, and its impact on surgical and oncological outcomes. Survival analysis included recurrence-free survival (RFS), as the time between diagnosis and disease recurrence; metastasis-free survival (MFS), as the time between diagnosis and metastasis onset; cancer-specific survival (CSS) and overall survival (OS), as the time between diagnosis and death by UTUC or from any cause, respectively. After adjusting for clinical features of the high-risk prognostic group, Cox proportional hazard model was used to evaluate significant predictors of time-to-event outcomes. Logistic regression analysis was performed to evaluate differences between patients receiving URS and, based on their URS status, to determine their likelihood of receiving kidney-sparing surgery and a specific surgical approach. Results: Overall, 1912 patients were included, 1035 undergoing URS and biopsy and 877 not receiving endoscopic diagnosis. A mean follow-up of 28.9 months was obtained. Patients undergoing pre-operative URS were more likely female (OR 0.67, 95% CI 0.51-0.87), with smaller (OR 0.31, 95% CI 0.22-0.43), and organ-confined tumors (OR 0.47, 95% CI 0.34-0.64), compared to patients not receiving URS. Robot-assisted RNU was the most common procedure (55.1%), in both subgroups. At survival analysis, CSS was significantly higher for patients undergoing URS (37 months vs 20 months, p<.001). However, the two cohorts were comparable in terms of RFS (p=.6), MFS (p=.3) and OS (p=.07). In Cox regression analysis, URS was not a significant predictor of worse oncological outcomes for each time-to-event outcome. Likewise, in logistic regression analysis, pre-operative ureteroscopy was not a significant predictor of a certain surgical approach or technique. Conclusions: Within the limitations related to the retrospective study design, our findings suggest that diagnostic ureteroscopy is performed mostly in patients with smaller localized tumors. Patients undergoing ureteroscopy had a longer CSS, even though statistical significance was lost at Cox analysis. Surgical strategy is likely determined more by tumour features than by ureteroscopy findings.
Volume
85
First Page
S713
Last Page
S714
