Thomas Seisen1, Laurent Nison2, Mezut Remzi3, Tobias Klatte4, Romain Mathieu4, Ilaria Lucca4, Grégory Bozzini2, Umberto Capitanio5, Giacomo Novara6, Olivier Cussenot7, Eva Compérat8, Raphaële Renard-Penna9, Benoit Peyronnet10, Axel S Merseburger11, Hans-Martin Fritsche12, Milan Hora13, Shahrokh F Shariat4, Pierre Colin14, Morgan Rouprêt15. 1. Academic Department of Urology, University Hospital Pitié Salpétrière, Paris, France; UPMC Universitaire Paris 06, GRC5, ONCOTYPE-Uro and Institut Universitaire de Cancérologie, Paris, France. 2. Academic Department of Urology, University Hospital Claude Huriez, Lille, France. 3. Academic Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria. 4. Academic Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria. 5. Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele University, Milan, Italy. 6. Department of Surgery, Oncology and Gastroenterology-Urology Clinic, University of Padua, Padua, Italy. 7. Academic Department of Urology, University Hospital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; UPMC Universitaire Paris 06, GRC5, ONCOTYPE-Uro and Institut Universitaire de Cancérologie, Paris, France. 8. Academic Department of Pathology, University Hospital Pitié Salpétrière, Paris, France. 9. Academic Department of Radiology, University Hospital Pitié Salpétrière, Paris, France. 10. Academic Department of Urology, University Hospital Pontchaillou, Rennes, France. 11. Academic Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany. 12. Academic Department of Urology, St. Josef Medical Center, University of Regensburg, Germany. 13. Academic Department of Urology, Faculty Hospital Plzeň and Charles University in Prague, Faculty of Medicine in Plzeň, Plzeň, Czech Republic. 14. Department of Urology, Private Hospital La Louvière, Lille, France. 15. Academic Department of Urology, University Hospital Pitié Salpétrière, Paris, France; UPMC Universitaire Paris 06, GRC5, ONCOTYPE-Uro and Institut Universitaire de Cancérologie, Paris, France. Electronic address: morgan.roupret@psl.aphp.fr.
Abstract
PURPOSE: We compared the oncologic outcomes of radical nephroureterectomy, distal ureterectomy and endoscopic surgery for elective treatment of clinically organ confined upper tract urothelial carcinoma of the distal ureter. MATERIALS AND METHODS: From a multi-institutional collaborative database we identified 304 patients with unifocal, clinically organ confined urothelial carcinoma of the distal ureter and bilateral functional kidneys. Rates of overall, cancer specific, local recurrence-free and intravesical recurrence-free survival according to surgery type were compared using Kaplan-Meier statistics. Univariable and multivariable Cox regression analyses were performed to assess the adjusted outcomes of radical nephroureterectomy, distal ureterectomy and endoscopic surgery. RESULTS: Overall 128 (42.1%), 134 (44.1%) and 42 patients (13.8%) were treated with radical nephroureterectomy, distal ureterectomy and endoscopic surgery, respectively. Although rates of overall, cancer specific and intravesical recurrence-free survival were equivalent among the 3 surgical procedures, 5-year local recurrence-free survival was lower for endoscopic surgery (35.7%) than for nephroureterectomy (95.0%, p <0.001) or ureterectomy (85.5%, p = 0.01) with no significant difference between nephroureterectomy and distal ureterectomy. On multivariable analyses only endoscopic surgery was an independent predictor of decreased local recurrence-free survival compared to nephroureterectomy (HR 1.27, p = 0.001) or distal ureterectomy (HR 1.14, p = 0.01). Distal ureterectomy and endoscopic surgery did not significantly correlate to cancer specific or intravesical recurrence-free survival. However, when adjustment was made for ASA(®) (American Society of Anesthesiologists(®)) score, distal ureterectomy (HR 0.80, p = 0.01) and endoscopic surgery (HR 0.84, p = 0.02) were independent predictors of increased overall survival, although no significant difference was found between them. CONCLUSIONS: Because of better oncologic outcomes, distal ureterectomy could be considered the elective first line treatment of clinically organ confined urothelial carcinoma of the distal ureter.
PURPOSE: We compared the oncologic outcomes of radical nephroureterectomy, distal ureterectomy and endoscopic surgery for elective treatment of clinically organ confined upper tract urothelial carcinoma of the distal ureter. MATERIALS AND METHODS: From a multi-institutional collaborative database we identified 304 patients with unifocal, clinically organ confined urothelial carcinoma of the distal ureter and bilateral functional kidneys. Rates of overall, cancer specific, local recurrence-free and intravesical recurrence-free survival according to surgery type were compared using Kaplan-Meier statistics. Univariable and multivariable Cox regression analyses were performed to assess the adjusted outcomes of radical nephroureterectomy, distal ureterectomy and endoscopic surgery. RESULTS: Overall 128 (42.1%), 134 (44.1%) and 42 patients (13.8%) were treated with radical nephroureterectomy, distal ureterectomy and endoscopic surgery, respectively. Although rates of overall, cancer specific and intravesical recurrence-free survival were equivalent among the 3 surgical procedures, 5-year local recurrence-free survival was lower for endoscopic surgery (35.7%) than for nephroureterectomy (95.0%, p <0.001) or ureterectomy (85.5%, p = 0.01) with no significant difference between nephroureterectomy and distal ureterectomy. On multivariable analyses only endoscopic surgery was an independent predictor of decreased local recurrence-free survival compared to nephroureterectomy (HR 1.27, p = 0.001) or distal ureterectomy (HR 1.14, p = 0.01). Distal ureterectomy and endoscopic surgery did not significantly correlate to cancer specific or intravesical recurrence-free survival. However, when adjustment was made for ASA(®) (American Society of Anesthesiologists(®)) score, distal ureterectomy (HR 0.80, p = 0.01) and endoscopic surgery (HR 0.84, p = 0.02) were independent predictors of increased overall survival, although no significant difference was found between them. CONCLUSIONS: Because of better oncologic outcomes, distal ureterectomy could be considered the elective first line treatment of clinically organ confined urothelial carcinoma of the distal ureter.
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