To assess whether radical nephroureterectomy (RNU) confers oncologic and perioperative benefit in patients aged 80 years or older with upper tract urothelial carcinoma (UTUC).
This retrospective cohort study included 710 patients who underwent RNU at a tertiary center from 2003 to 2022. Patients were stratified into octogenarian (OG) (≥80 years, n=96) and non-octogenarian (NOG) (<80 years, n=614) groups. Demographics, perioperative variables, and oncologic outcomes were compared. Multivariate Cox regression was performed for overall survival and cancer-specific survival (CSS).
OG had a higher rate of hypertension (72.9% vs. 50.2%) and lower body mass index (23.6 kg/m² vs. 24.5 kg/m², p=0.028), with similar pathologic stage and tumor grade compared to NOG. OG were more likely to undergo minimally invasive surgery (84.3% vs. 75.3%, p<0.001). Overall complication rate was higher in OG (68.8% vs. 55.2%, p=0.013), but major complications were not (5.2% vs. 3.3%, p=0.340). At median follow-up of 43.6 months, no difference in CSS was found. Positive surgical margin was the only independent predictor of CSS.
RNU can be safely and effectively performed in well-selected OG with UTUC. Age ≥80 years was not associated with inferior CSS outcomes or increased major morbidity.
Investigative and clinical urology. 2026 Mar [Epub]
Sang Hun Song, Haesung Lee, Younsoo Chung, Byeongdo Song, Hakmin Lee, Jong Jin Oh, Sangchul Lee, Seok-Soo Byun, Sung Kyu Hong
Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea., Department of Urology, Hanyang University College of Medicine, Seoul, Korea.