Evaluate long-term oncologic outcomes of patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU) and the impact of diagnostic ureteroscopy (URS) on survival outcomes.
A retrospective analysis of all consecutive patients undergoing RNU for suspected UTUC at a UK tertiary referral centre from a prospectively maintained database. The primary outcome measures were 5 and 10 years CSS. The secondary outcomes were: Overall Survival (OS), Recurrence Free Survival (RFS), impact of prior diagnostic URS on OS, CSS and intra-vesical Recurrence Free Survival (IV-RFS) and predictors of intra-vesical recurrence. Statistical analysis was performed in R using the 'survminer' and 'survival' packages. The Kaplan-Meier method was used to calculate survival functions and expressed in graphical form. Uni-/multivariate survival analyses were performed using the Cox proportional hazard regression model. Statistical significance in this study was set as P < 0.05 RESULTS: 422 patients underwent RNU with confirmed UTUC. The median follow-up of patients with confirmed UTUC was 9.2 (IQR:5.6yrs-12.7 yrs). The 5- and 10-year Cancer Specific survival was 70.5% [95%CI:65.9%-74.9%] and 67.1% [95%CI:62.4%-71.6%] respectively. OS and CSS were similar in diagnostic URS cohort and direct RNU cohort (OS; HR [95% CI] 1.04 [0.78-1.38]; p-0.46), (CSS; HR [95% CI] 0.96 [0.68-1.34]; p-0.81). IV-RFS was superior for the direct RNU cohort [95% CI] 1.94, [1.19-3.17]; p-0.008. On a multivariate analysis Prior URS, T2 stage, proximal ureter tumours and a prior bladder cancer history were predictors of metachronous bladder recurrence CONCLUSION: This single centre retrospective cohort study reports long-term oncological outcomes of RNU with a median follow up of 9.2 years, serving as a reference standard in counselling patients following an RNU. Stage and grade of the NU specimen were the only 2 studied factors that appeared to adversely impact long-term CSS and OS. Our results suggest that the risk of intravesical recurrence is increased nearly two-fold in patients who have had a diagnostic URS prior to RNU. Prior URS however does not appear to adversely impact long term CSS and OS. The authors would suggest that a risk-stratified approach be adopted, wherein diagnostic URS are offered only in equivocal cases.
BJU international. 2021 Nov 02 [Epub ahead of print]
Rajan Veeratterapillay, Robert Geraghty, Rajadoss Pandian, Chloe Roy, Georgie Stenhouse, Clare Bird, Naeem Soomro, Edgar Paez, Alistair Rogers, Mark Johnson, Toby Page, David Rix, David Thomas, Bhavan Prasad Rai
Freeman Hospital, Newcastle, UK.