OBJECTIVE - Open nephroureterectomy (ONU) is the current standard for muscle-invasive upper tract urothelial carcinoma (UTUC) in the European Association of Urology/Japanese Urological Association guidelines. Here we compared the postsurgical survival of muscle-invasive UTUC patients treated with ONU or with laparoscopic nephroureterectomy (LNU), using the multi-institutional national database of the Japanese Urological Association.
METHODS - The 1,509 patients with UTUC who were diagnosed at 348 Japanese institutions in 2005 were registered. We collected the clinical data of the patients in 2011. The muscle-invasive UTUC patients who underwent ONU or LNU were identified, and survival curves were estimated using the Kaplan-Meier method.
RESULTS - Overall, 749 pT2≥cNxM0 patients underwent a nephroureterectomy (ONU, n=527 and LNU, n=222). The overall survival and cause-specific survival rates were not significantly different between the ONU and LNU groups (P=0. 1263 and P=0. 0893, respectively). In addition, 459 of the 749 (61. 3%) patients experienced disease recurrence (bladder recurrence, local recurrence or distant metastasis), with no significant difference between the ONU and LNU groups. Even when patients were stratified by pT3/pT4 and/or pN+, overall survival was not significantly different between the ONU and LNU groups (P=0. 2876). The results of a univariate analysis showed that lymphovascular invasion was an independent prognostic factor for overall survival, but the surgical approaches were not found to be associated with overall survival.
CONCLUSION - Our data suggest that there is no evidence that the oncological outcome of LNU is inferior to that of ONU in muscle-invasive UTUC, when the appropriate patients are selected.
Journal of endourology / Endourological Society. 2015 Dec 16 [Epub ahead of print]
Jun Miyazaki, Hiroyuki Nishiyama, Hiroyuki Fujimoto, Chikara Ohyama, Takuya Koie, Shiro Hinotsu, Eiji Kikuchi, Mizuaki Sakura, Junichi Inokuchi, Tomohiko Hara
Faculty of Medicine, Urology , Tsukuba University , 1-1-1 Tennodai , Tsukuba City Ibaraki pref. , Japan , 305-8575 , +81-29-853-3223 , +81-29-853-8854 ; Tsukuba City, Japan ; National Cancer Center, Urology, Tokyo, Japan ; Hirosaki University Graduate School of Medicine, Urology, Hirosaki, Japan ; Hirosaki University Graduate School of Medicine, Urology, Hirosaki City, Japan ; Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan ; Keio University School of medicine , Urology , 35 Shinanomachi, Shinjiku-ku , Tokyo, Japan , 160-8582 , +81-3-5363-3825 , +81-3-3225-1985 ; Cancer Institute Hospital, Japanese Foundation of Cancer Research, Urology, Tokyo, Japan ; Kyushu university, Urology , 3-1-1 Maidashi , Higashi-ku , Fukuoka, Fukuoka, Japan , 812-8582 , +81-92-642-5603 , +81-642-5618 ; National Cancer Center Hospital, Urology, Tokyo, Japan