The European Association of Urology (EAU), American Urological Association (AUA) and National Comprehensive Cancer Network (NCCN) guidelines (GL) represent key international standards for clinical practice. We assessed the adherence to EAU-AUA- NCCN GL in a large real-world multicenter cohort of patients with Upper Tract Urothelial Carcinoma (UTUC), treated with nephroureterectomy.
A multicenter retrospective analysis from the ROBUUST (ROBotic surgery for Upper tract Urothelial cancer STudy) registry was performed to assess the region-specific adherence rates to guidelines (GL) for perioperative treatments and their impact on oncological outcomes was evaluated with the Kaplan-Meier method.
Out of 2307 patients, excision was the most adopted approach for bladder cuff management world-wide (USA 88.6%, EU 90.5%, Asia 89.8%). Postoperative bladder instillation (intravesical chemotherapy) was implemented in 28.4% of all cases and did not impact bladder recurrence-free survival (log rank P=0.45). Lymphadenectomy (LND) in high-risk disease was underused in both locally advanced (cT3-4: USA 35.8%, EU 46.8%, A 25%) and cN+ stages (USA 41.9%, EU 47.9%, A 43%). LND was not associated with better cancer-specific survival (CSS) across all stages (log rank P≥0.53). Adjuvant chemotherapy (AdCHT) was administered overall in 27.8% of pT2-T4 cases, with a significantly higher adoption in Asia (P=0.03); while in pN+ disease, AdCHT rate was 30.2% and did not convey any advantage in CSS (P=0.58). Retrospective design is the main limitation of the present study.
The present contemporary "real world" data suggests poor adherence to current EAU-AUA guidelines for key indicators of quality care such as perioperative bladder instillation of chemotherapy, performance of LND and administration of adjuvant chemotherapy for advanced disease. These findings highlight the need of improving the implementation of these guideline driven treatment strategies.
Minerva urology and nephrology. 2026 Apr [Epub]
Mariaconsiglia Ferriero, Gabriele Tuderti, Flavia Proietti, Giuseppe Chiacchio, Gabriele Bignante, Zhenjie Wu, Linhui Wang, Vitaly Margulis, Raj Bhanvadia, Firas Abdollah, Nicholas B Cusumano, Alessandro Antonelli, Francesco Ditonno, Alessandro Veccia, Nirmish Singla, Stephan Brönimann, Ithaar H Derweesh, Dhruv Puri, Margaret F Meagher, Soroush Rais-Bahrami, Sol C Moon, Matteo Ferro, Ottavio DE Cobelli, Francesco Porpiglia, Daniele Amparore, Enrico Checcucci, Randall Lee, Andres F Correa, Daniel D Eun, Mark L Gonzalgo, Omri F Nativ, Sisto Perdonà, Antonio Tufano, Ahmed Eraky, Reza Mehrazin, Courtney Yong, Chandru P Sundaram, Takashi Yoshida, Hidefumi Kinoshita, Alireza Ghoreifi, Farshad S Moghaddam, Hooman Djaladat, Riccardo Autorino, Giuseppe Simone
Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy - ., Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy., Department of Urology, Rush University, Chicago, IL, USA., Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA., Department of Urology, University of Verona, Verona, Italy., The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University, Baltimore, MD, USA., Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA., Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA., Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy., Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy., Fox Chase-Temple Urologic Institute, Philadelphia, PA, USA., Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA., Uro-Gynecological Department, Fondazione G. Pascale IRCCS, Naples, Italy., Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA., Department of Urology, Indiana University, Indianapolis, IN, USA., Department of Urology and Andrology, Kansai Medical University, Osaka, Japan., Department of Urology, Duke University, Durham, NC, USA., Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA.