To test for survival differences after radical nephroureterectomy (RNU) in pT1-T3N0 upper tract urothelial carcinoma (UTUC) patients according to bladder cuff excision (BCE) status.
Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified RNU patients and documented BCE status.
Prior and after propensity score matching (ratio 1:1), cumulative incidence plots and competing risk regression (CRR) models addressed cancer specific mortality (CSM) and other-cause mortality (OCM).
Of 4,426 RNU-treated patients, 3,186 (72%) patients underwent BCE and 1,240 (28%) did not. BCE rates significantly increased over time from 65.2 to 77.0% (EAPC: +1.0%, 95% CI +0.4 to +1.6%, P = 0.004) between 2004 and 2020. After 1:1 propensity score matching for T stage, 1,240 of 1,240 (100%) RNU patients without BCE and 1,240 of 3,186 (39%) RNU patients with BCE were included in subsequent analyses. Five-year CSM rates were 30% in RNU with BCE vs. 36% in RNU without BCE patients (Δ = 6%). In multivariable CRR, RNU with BCE independently predicted lower CSM (HR: 0.81, 95% CI: 0.70-0.93; P < 0.001). Conversely, BCE status did not affect OCM (P = 0.4).
The rate of guideline recommended BCE at RNU increased over time. Additionally, RNU with BCE is associated with significantly lower CSM than RNU without BCE in pT1-T3N0 UTUC patients. In consequence, BCE should represent an integral part of a comprehensive RNU.
Urologic oncology. 2025 Mar 20 [Epub ahead of print]
Francesco Di Bello, Carolin Siech, Mario de Angelis, Natali Rodriguez Peñaranda, Letizia Maria Ippolita Jannello, Zhe Tian, Jordan A Goyal, Claudia Collà Ruvolo, Gianluigi Califano, Francesco Mangiapia, Fred Saad, Shahrokh F Shariat, Ottavio de Cobelli, Alberto Briganti, Felix K H Chun, Salvatore Micali, Nicola Longo, Pierre I Karakiewicz
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy. Electronic address: ., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt, Germany., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada., Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan., Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy., Department of Urology, Vita-Salute San Raffaele University, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy., Goethe University Frankfurt, University Hospital, Department of Urology, Frankfurt, Germany., Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/40118680