AUA 2019: Propensity Score Matched Comparison of Oncologic and Functional Outcomes Between Radical Nephroureterectomy and Segmental Ureterectomy

Chicago, IL ( Radical nephroureterectomy is the standard treatment for upper tract urothelial carcinoma (UTUC). However, nephron-sparing surgery in this entity has emerged as an alternative option. In this study, the authors attempted to compare oncological and functional outcomes between patients treated with radical nephroureterectomy and segmental ureterectomy in UTUC.

This was a retrospective study with patients treated between 2008 and 2016. Propensity score matching was used (1:1) with adjustment for age, gender, year of surgery, T stage and disease grade. Kaplan Meier analysis was used to assess progression-free survival, cancer-specific survival, overall survival, upper tract-recurrence free survival, and intravesical recurrence-free survival. Lastly, the difference in postoperative glomerular filtration rate (GFR) war compared between both surgical modalities.

A total of 394 patients underwent radical nephroureterectomy, and 44 patients were treated with segmental ureterectomy during the study’s time. Following propensity score matching, 40 patients were included n the analysis. The basic clinicopathologic characteristics of the patients are shown in table 1. The various Kaplan-Meier curves comparing both surgical modalities in all patients are shown in figure 1. Figure 2 demonstrates Kaplan-Meier curves for patients with T stage >=2 only. All Kaplan Meier curves did not demonstrate any statistically significant difference between both surgical modalities. Lastly, GFR results of the patients in both groups are shown in table 2, 1 month and one year postoperatively, demonstrating that patients treated with segmental ureterectomy have improved GFR at all stages postoperatively. Importantly, 3/44 patients (6.8%) that underwent segmental ureterectomy had disease recurrence. One patient was treated with repeated endoscopic tumor resection, one patient underwent radical salvage nephroureterectomy, and the last patient had died.

In conclusion, no significant differences in progression-free survival, cancer-specific survival and overall survival between radical nephroureterectomy and segmental ureterectomy were demonstrated, regardless of stage or grade. Patients treated with segmental ureterectomy were shown to have improved postoperative renal function compared to patients treated with radical nephroureterectomy.

Table 1- Basic clinicopathologic patient characteristics:
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Figure 1- Kaplan Meier curves comparing radical nephroureterectomy to segmental ureterectomy:
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Figure 2 – Kaplan Meier curves comparing radical nephroureterectomy to segmental ureterectomy in patients with >=stage T2:
 AUA2019_Radical Nephroureterectomy and Segmental Ureterectomy_3.png

Table 2- GFR at one month and one year postoperatively in both surgical modalities:
 AUA2019_Radical Nephroureterectomy and Segmental Ureterectomy_4.png

Presented by: Si Hyung Sung, MD, Samsung Medical Center, Seoul South Korea

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois