Oncological outcomes of open versus minimally invasive nephroureterectomy for locally advanced upper tract urothelial carcinoma
Recommended Citation
Afferi L, Grossmann NC, Gallioli A, Cannoletta D, Moschini M, Soria F, Juvet T, Potretzke A, Djaladat H, Kikuchi E, Mari A, Khene Z, Raman JD, Sfakianos JP, Boormans JL, Antonelli A, Abdollah F, Ploussard G, Boorjian SA, Shariat SF, Heidenreich A, Mattei A, Breda A, Pradere B. Oncological outcomes of open versus minimally invasive nephroureterectomy for locally advanced upper tract urothelial carcinoma. Eur Urol 2025; 87(S1):542.
Document Type
Conference Proceeding
Publication Date
3-1-2025
Publication Title
Eur Urol
Abstract
Introduction & Objectives: It is currently recommended to perform open radical nephroureterectomy (oRNU) with bladder cuff excision in patients with locally advanced (cT3-4 or cN1-2) upper tract urothelial carcinoma (laUTUC). We tested the hypothesis that bladder recurrence-free survival (BRFS), metastasis-free survival (MFS), CSS, and overall survival (OS) are not influenced by the surgical approach in patients with laUTUC using a large multicenter series. Materials & Methods: This is a multicenter retrospective cohort study including 361 patients with cT3-4 or cN1-2 cM0 laUTUC treated with oRNU or minimally invasive RNU (miRNU) from 1999 to 2019 at 21 academic centers in Europe, Asia, and the United States. Missing values of relevant baseline characteristics were estimated through multiple imputation of chained equations. Baseline patients' heterogeneity for age, body mass index, American Society of Anesthesiologists score, charlson comorbidity index, cTNM, and administration of neoadjuvant chemotherapy was balanced using a 1:1 nearest neighbor propensity score matching (PSM) estimated using logistic regression. Uni- and multivariable Cox regression analyses for bladder recurrence, metastasis, cancer-specific death and overall death were performed. Kaplan Meier (KM) estimates and log-rank test were used to compare BRFS, MFS, CSS, and OS according to clinical and pathological features. Results: Median follow-up was 24 months (IQR = 12-46). After PSM, two cohorts of 115 laUTUC patients each with similar baseline and preoperative tumor characteristics were obtained. In the matched cohort, pT23 stage was found in 84 (73%) and 67 (58.3%) patients in the oRNU and miRNU groups, respectively. In the multivariable regression analysis, pT23 and positive lymph nodes were associated with increased risk of metastasis (HR 3.22, 95% CI 1.26-8.23, and HR 4.03, 95% CI 2.05 - 7.89, respectively). The surgical approach did not influence oncological outcomes as shown by uni- and multivariable analyses and KM estimates, regardless of pT stage. Conclusions: The oncological outcomes of laUTUC for cT3-4 or cN1-2 cM0 disease are comparable between oRNU and miRNU. Therefore, the decision to opt for oRNU or miRNU should be guided by the surgeon's expertise and the patient's comorbidities, rather than concerns over long-term oncological outcomes associated with either surgical technique.
Volume
87
Issue
S1
First Page
542
