Urologic Oncology: Seminars and Original Investigations
Original articleMulti-institutional analysis of renal function outcomes following radical nephroureterectomy and partial ureterectomy for upper tract urothelial carcinoma
Introduction
Upper tract urothelial carcinomas (UTUC) are uncommon, comprising approximately 5% of urothelial tumors [1], [2]. Radical nephroureterectomy (RNU) with removal of the distal ureter and bladder cuff is currently the referent gold standard treatment of UTUC [3], [4], [5], [6]. However, RNU has been shown to be an independent risk factor in the development of stage III chronic kidney disease (CKD) when compared with nephron-sparing techniques [7], [8], [9] and can amount to a significant decline in estimated glomerular filtration rate (eGFR) [10], [11], thereby decreasing eligibility for platinum-based chemotherapy [12], [13], [14].
Nephron-sparing strategies, such as partial ureterectomy (PU), may be an attractive alternative to RNU in appropriately selected patients. Studies have demonstrated comparable long-term mortality in PU and RNU, with similar oncologic control in advanced stage disease [3], [15], [16], [17]. In perhaps the largest series to date of an international, contemporary, multi-institutional comparison of RNU and PU for UTUC, Bagrodia et al. [18] demonstrated equivalent long-term oncologic efficacy between the 2. PU conceivably offers the advantage of maximizing global renal function in selected patients and may thereby increase eligibility for adjuvant or salvage chemotherapy, while minimizing adverse outcomes associated with nephron loss. In the present study, we compare baseline and postoperative renal functional outcomes between RNU and PU in a multi-institutional contemporary cohort of patients with UTUC.
Section snippets
Materials and methods
Following institutional review board approval, a multi-institutional retrospective database was created containing clinicopathologic data of all patients undergoing RNU or PU for UTUC between 1998 and 2012 at the University of Texas Southwestern Medical Center (Dallas, TX) and the University of California San Diego (San Diego, CA). Patient demographics, comorbidities, and disease properties including tumor location, multifocality, pathologic stage, grade, concomitant carcinoma in situ, presence
Results
Clinicopathologic characteristics of our cohort are summarized in Table 1. In total, 193 patients were included, of whom 143 (74.1%) underwent RNU and 50 (25.9%) underwent PU. Median follow-up duration was 25.9 months (range: 1−150 months) following surgery, with a significantly longer median follow-up in the PU group (22.4 months [interquartile range {IQR}: 6.4−42.1] vs. 43.9 months [IQR: 18.8−82.1], P = 0.001). Median age was 69 years, and most were men (69.4%). In comparing the RNU and PU
Discussion
With the growing role for nephron-sparing approaches in the treatment of UTUC, we sought to compare renal function outcomes between RNU and PU in a multi-institutional contemporary cohort of patients with UTUC. Conceivably, the effect of surgical approach on renal function may affect eligibility for and appropriate timing of systemic chemotherapy administration in those who would derive benefit. We found that across all time points, though the difference did not achieve statistical
Conclusions
We conclude that operation type does not appear to be significantly associated with new-onset stage III CKD or worsening of CKD stage within the first 3 months following surgery for UTUC within our cohort. Patients undergoing RNU tend to have worse tumor characteristics and baseline renal function than PU patients. Meanwhile, the higher rate of adjuvant chemotherapy in the PU arm likely explains the lack of improvement in eGFR within that group. These results must be interpreted with the
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Oncologic outcomes of patients treated with kidney-sparing surgery or radical nephroureterectomy for upper urinary tract urothelial cancer: a population-based study
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2023, Urologic Oncology: Seminars and Original InvestigationsPathologic stage as a surrogate for oncologic outcomes after receipt of neoadjuvant chemotherapy for high-grade upper tract urothelial carcinoma
2020, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :Specific indications for receipt of NAC, however, are not well defined [19], and UTUC is notoriously difficult to stage accurately due to limitations of endoscopic biopsy techniques and current imaging modalities [20,21]. Furthermore, only 37 to 49% of patients with UTUC are eligible for platinum-based chemotherapy preoperatively owing to poor baseline renal function [22,23], often lowered further after RNU [24–27]. Aside from theoretical eradication of micrometastatic disease, survival benefits from receipt of NAC in patients with localized UTUC may also relate to pathologic downstaging of the primary tumor, which has been reported in analyses of the National Cancer Database (NCDB) and institutional series [14,16,17,28,29].
Segmental Ureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis of Comparative Studies
2020, Clinical Genitourinary CancerCitation Excerpt :Figure 1 reports the study selection PRISMA flow chart. Eighteen comparative studies were deemed eligible for meta-analysis.13-30 No randomized controlled trial was available, all the studies were retrospective, and only one was prospective.16