Photo Credit: Jitendra Jadhav

The following is a summary of “Decisional and prognostic impact of diagnostic ureteroscopy in high-risk upper tract urothelial carcinoma: A multi-institutional collaborative analysis (ROBUUST collaborative group),” published in the May 2024 issue of Urology by Ditonno et al.

Diagnostic ureteroscopy (URS), with or without biopsy, remains contentious in managing upper tract urothelial carcinoma (UTUC), with divergent guidelines influencing clinical practice. This study aimed to assess the decision-making and prognostic impact of URS in patients with high-risk UTUC undergoing curative surgery. A retrospective multi-institutional analysis was conducted using data from the ROBUUST dataset, comparing patients who underwent preoperative URS and biopsy with those who did not. Logistic regression evaluated differences in treatment decisions, while survival analyses included 5-year recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). After adjusting for high-risk prognostic factors, Cox proportional hazard models identified significant predictors of these outcomes. Among 1,912 patients, 1,035 underwent URS and biopsy, and 877 did not, with a median follow-up of 24 months. 

Robot-assisted radical nephroureterectomy was the predominant procedure (55.1%) in both groups. Patients who underwent URS showed significantly higher 5-year OS (P = 0.04) and CSS (P < 0.001) compared to those who did not, while RFS (P = 0.6) and MFS (P = 0.3) did not differ significantly between the groups. Preoperative URS and biopsy did not predict worse oncological outcomes or dictate specific treatment modalities, suggesting that its benefit in OS and CSS may stem from better patient selection for curative interventions rather than influencing treatment strategies based on URS findings alone.

Source: sciencedirect.com/science/article/pii/S107814392400440X