Real-world management of high-risk upper tract urothelial carcinoma: Level of adherence to EAU guidelines - analysis of the ROBUUST registry
Recommended Citation
Tuderti G, Proietti F, Wu Z, Franco A, Abdollah F, Finati M, Ferro M, Tozzi M, Porpiglia F, Checcucci E, Margulis V, Singla N, Derweesh IH, Correa A, Gonzalgo ML, Mehrazin R, Sundaram CP, Tufano A, Perdonà S, Djaladat H, Ditonno F, Antonelli A, Autorino R, Simone G. Real-world management of high-risk upper tract urothelial carcinoma: Level of adherence to EAU guidelines - analysis of the ROBUUST registry. Eur Urol 2024; 85:S798-S799.
Document Type
Conference Proceeding
Publication Date
3-1-2024
Publication Title
Eur Urol
Abstract
Introduction & Objectives: The European Association of Urology (EAU) guidelines (GL) for Upper Tract Urothelial Carcinoma (UTUC) are mainly based on retrospective studies. We aimed to assess the adherence to EAU GL in a large multicenter cohort of patients with UTUC, treated with nephroureterectomy (NU). Materials & Methods: A multicenter retrospective analysis utilizing the ROBUUST (ROBotic surgery for Upper tract Urothelial cancer Study) registry was performed. We assessed the region-specific GL adherence rates for bladder cuff management, post-operative bladder instillation, adoption of adjuvant chemotherapy (AdCHT), and performance of lymphadenectomy (LND). We subsequently assessed the impact of these variables on oncologic outcomes with the Kaplan-Meier (KM) method. Results: Overall, data of 2,307 patients were evaluated. With regard to bladder cuff management, excision was the most adopted approach world-wide (US 88.6%, Europe (EU) 90.5%, Asia (A) 89.8%). Regarding post-operative bladder instillation, although strongly recommended, its adoption rate was only 28.4%; notably, at KM analysis patients receiving instillation did not display improved bladder recurrence-free survival (BRFS) (p=0.45). Concerning LND, harbouring a weak recommendation for muscle-invasive disease, it appears underused in both locally advanced (cT3-4: US 35.8%, EU 46.8%, A 25%) and cN positive stages (US 41.9%, EU 47.9%, A 43%); however, at KM analysis, patients receiving LND had not any benefit in terms of cancer-specific survival (CSS); this data was homogenous across all stages (all p≥0.53). Concerning the use of AdCHT, strongly recommended for pT2–T4 and/or pN+ disease, overall administration rate was only 27.7% for pT2-T4, with a significantly higher adoption in Asia (p=0.03); moreover, in pN+ disease, overall its use was 30.2%, homogeneously low across all regions. At KM analysis, patients receiving AdCHT hadn't significant CSS benefit. Conclusions: Real word data highlights poor adherence to the UTUC EAU GL for all main topics, namely post-operative bladder instillation, performance of LND and AdCHT administration for advanced stages of disease. Despite the retrospective nature of data, real word data seem to support the need for further research supporting clinical benefits of these intra and postoperative procedure. [Figure presented]
Volume
85
First Page
S798
Last Page
S799
