Kidney-Sparing Surgery Versus Radical Nephroureterectomy for High-Grade Organ-Confined Upper Tract Urothelial Carcinoma: Analysis of the ROBUUST Registry
Recommended Citation
Proietti F, Tuderti G, Autorino R, Derweesh IH, Wu Z, Singla N, Djaladat H, Lee R, Margulis V, Antonelli A, Minervini A, Abdollah F, Yoshida T, Shiota M, Sundaram CP, Gonzalgo ML, Perdonà S, Ferro M, Rais-Bahrami S, Porpiglia F, Mehrazin R, Ghodoussipour S, Simone G. Kidney-Sparing Surgery Versus Radical Nephroureterectomy for High-Grade Organ-Confined Upper Tract Urothelial Carcinoma: Analysis of the ROBUUST Registry. Eur Urol 2026; 89.
Document Type
Conference Proceeding
Publication Date
3-1-2026
Publication Title
Eur Urol
Keywords
adult, aged, cancer specific survival, cohort analysis, complication, conference abstract, controlled study, drug combination, drug therapy, female, follow up, human, kidney function, major clinical study, male, nephroureterectomy, overall survival, surgery, transitional cell carcinoma, tumor volume
Abstract
Introduction & Objectives: Kidney-sparing surgery (KSS) is recommended for low-risk upper tract urothelial carcinoma (UTUC), whereas its role in high-grade, organ-confined disease remains controversial. This study aimed to compare perioperative, functional, and oncologic outcomes of KSS and radical nephroureterectomy (NUT) in patients with high-grade UTUC fulfilling all other low-risk criteria. Materials & Methods: Patients with unifocal, <2 cm, ≤cT2 cN0 cM0, high-grade UTUC treated with either KSS or NUT between 2010 and 2025 were selected from ROBUUST registry. Baseline and perioperative characteristics were compared using Mann–Whitney and χ2/Fisher's exact tests. A 1:1 nearest-neighbor matching was performed according to AJCC stage and age to generate a balanced comparison. Cancer-specific survival (CSS) and overall survival (OS) were assessed using Kaplan–Meier estimates and compared with the log-rank test. Results: A total of 156 patients were included (52 KSS, 104 NUT). KSS patients were younger (69 vs 73 years, p=0.02). At final pathology, AJCC stage distribution differed significantly between groups (p<0.001). After matching, a sub-cohort of 42 patients (21 per group) was obtained. Baseline characteristics were balanced, although tumor size was smaller in the KSS group (1.4 vs 1.8 cm, p=0.01). While baseline eGFR was slightly higher in the NUT group (67.0 vs 66.6 mL/min/1.73 m2; p=0.03), renal function at 3 and 12 months showed no significant differences (both p>0.06).Kaplan–Meier analysis demonstrated no difference in CSS (log-rank=0.52) or OS (log-rank=0.65) between KSS and NUT. (Figure presented) Conclusions: In patients with high-grade but organ confined UTUC, KSS provides perioperative safety, functional preservation, and oncologic outcomes comparable to NUT. When performed in experienced centers, KSS may represent a valid alternative to radical surgery, but this finding warrants confirmation in prospective, larger trials with longer follow-up.
Volume
89
