Radical therapy for low-risk upper tract urothelial carcinoma (ROBUUST collaborative group)
Recommended Citation
Corsi N, Pandolfo S, Eilender BM, Bell SH, Wang L, Tuderti G, Ghoreifi A, Tozzi M, Taylor J, Dhanji S, Yong C, Checcucci E, Derweesh IH, Eun DD, Porpiglia F, Gonzalgo ML, Mehrazin R, Simone G, Ferro M, Margulis V, Sundaram CP, Djaladat H, Wu Z, Autorino R, and Abdollah F. Radical therapy for low-risk upper tract urothelial carcinoma (ROBUUST collaborative group). Eur Urol 2023; 83:S1324-S1325.
Document Type
Conference Proceeding
Publication Date
2-1-2023
Publication Title
Eur Urol
Abstract
Introduction & Objectives: Inaccurate preoperative staging is common in upper tract urothelial carcinoma (UTUC). It is useful to stratify low- and high-risk disease to appropriately select patients more likely to benefit from renal-sparing surgery (RSS) versus radical nephroureterectomy (RNU). We provide an update of contemporary management of low-risk UTUC across high volume centers and hypothesize that many low-risk patients are still frequently treated with RNU.
Materials & Methods: Patients were abstracted from an international cohort of 13 high-volume centers in the United States, Europe, and Asia (Robotic surgery for Upper Tract Urothelial Cancer Study, ROBUUST 2.0) undergoing treatment for UTUC from 2011-2022. We focused on patients with cN0M0 low-risk disease, as defined by: Unifocal disease, tumor size <2 cm, negative for high-grade cytology, low-grade on ureteroscopic biopsy, and no invasive aspect on preoperative CT. Clinical, pathologic, and recurrence data was collected. Descriptive statistics and Kaplan-Meier survival curves with log rank testing were performed. A trend analysis was completed to evaluate low-risk treatment modality by year.
Results: Of the 1596 cases, 148 patients met the criteria of low-risk disease. 90% were treated with RNU. Trend analysis showed a peak utilization of RNU for low-risk disease around years 2016-2018, with a decline in more recent years (Figure 1A). Mean age at surgery was 69.3 (11.9) years, with most patient's males (62%), normal weight (BMI: 24.7±5.3), ECOG of 0 (66%), and no prior history of bladder cancer (91%). Mean follow-up time was 40 months, and 52% of patients were ≤pT1 on final pathology. 15.6% (21/134) experienced recurrence following treatment with RNU, with a mean time to recurrence 21.8 (23.2) months. 57% (8/14) experienced recurrence following RSS, with a mean time to recurrence of 14.6 (10.6) months (Figure 1B; log-rank p = 0.62). Most recurred within the bladder (90% in RNU, 50% in RSS) with the other recurrences occurring in the ipsilateral/contralateral upper urinary tract. No distant recurrences were recorded in RSS.
Conclusions: A significant majority of low-risk patients still undergo RNU. While recurrence rate was higher in RSS (albeit non-statistically significant), none of these recurrences represented a distant metastasis. Our results should be considered within the framework of a retrospective design but provide insight to treatment patterns at high volume centers.
Volume
83
First Page
S1324
Last Page
S1325
