Survival Effect of Nephroureterectomy in Metastatic Upper Urinary Tract Urothelial Carcinoma.

Few data examined the potential survival benefit of nephroureterectomy (NU) in the setting of metastatic upper urinary tract urothelial carcinoma (mUTUC). We hypothesized that a survival benefit might be associated with the use of NU in that setting and tested this hypothesis within a large population-based cohort.

Within the Surveillance, Epidemiology, and End Results database (2004-2014), we identified 1174 patients with mUTUC. Kaplan-Meier plots, as well as multivariable Cox regression models (MCRMs), relying on inverse probability after treatment weighting and landmark analyses, were used to test the effect of NU versus no surgical treatment on cancer-specific mortality (CSM) in patients with mUTUC.

Of 1174 patients with mUTUC, 449 (38%) underwent NU. The rate of NU decreased over time from 47.1% to 34.6% (estimated annual percentage change, -4%; P = .006]. In MCRMs, NU achieved independent predictor status for lower CSM (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.46-0.66; P < .001). In MCRMs stratified according to chemotherapy, NU also achieved independent predictor status for lower CSM, both in patients who received (n = 597; 50.9%) (HR, 0.68; 95% CI, 0.53-0.87; P = .002) or did not receive (n = 574; 49%) (HR, 0.44; 95% CI, 0.33-0.58; P < .001) chemotherapy. Virtually the same results were recorded after inverse probability after treatment weighting adjustment, as well as in landmark analyses.

Our analyses suggest a potential survival benefit after NU in the setting of mUTUC, regardless of chemotherapy administration.

Clinical genitourinary cancer. 2019 Mar 29 [Epub ahead of print]

Sebastiano Nazzani, Felix Preisser, Elio Mazzone, Michele Marchioni, Marco Bandini, Zhe Tian, Francesco A Mistretta, Shahrokh F Shariat, Denis Soulières, Fred Saad, Emanuele Montanari, Stefano Luzzago, Alberto Briganti, Luca Carmignani, Pierre I Karakiewicz

Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du Cancer de Montréal, Montréal, Québec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy. Electronic address: ., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du Cancer de Montréal, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du Cancer de Montréal, Montréal, Québec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy Vita-Salute San Raffaele University, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du Cancer de Montréal, Montréal, Québec, Canada., Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du Cancer de Montréal, Montréal, Québec, Canada., Department of Urology, Istituto Europeo di Oncologia, Milan, Italy., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, IRCCS Fondazione Ca' Granda-Ospedale Maggiore Policlinico University of Milan, Milan, Italy., Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy Vita-Salute San Raffaele University, Milan, Italy., Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.

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