Nephron-sparing ureteroscopic surgery vs. radical nephroureterectomy: comparable survival-outcomes in upper tract urothelial carcinoma.

Nov 06, 2023

Experts: Takuya Tsujino,Kazumasa Komura,Teruo Inamoto,Ryoichi Maenosono,Takeshi Hashimoto,Takahiro Adachi,Yosuke Hirasawa,Satoshi Tokushige,Takaya Ohno,Shogo Yamazaki,Tatsuo Fukushima,Ko Nakamura,Yusuke Yano,Kazuki Nishimura,Shoko Kinoshita,Keita Nakamori,Takeshi Tsutsumi,Tomohisa Matsunaga,Yuki Yoshikawa,Taizo Uchimoto,Tomoaki Takai,Koichiro Minami,Hirofumi Uehara,Hajime Hirano,Hayahito Nomi,Kiyoshi Takahara,Yoshio Ohno,Haruhito Azuma

This study investigates the utility of ureteroscopic surgery (URS) as an alternative to radical nephroureterectomy (RNU) in managing upper tract urothelial carcinoma (UTUC), with a focus on survival outcomes and re-evaluation of current the European Association of Urology guidelines criteria.
We conducted a retrospective, multi-institutional review of 143 UTUC patients treated with URS (n = 35) or RNU (n = 108). Clinicopathological factors were analyzed, and survival outcomes were assessed using Kaplan-Meier analysis and Cox proportional-hazards models.
The median follow-up period was 27 months. Overall survival (OS) and radiographic progression-free survival (rPFS) were comparable between the URS and RNU groups (OS: HR 2.42, 95% CI 0.63-9.28, P = 0.0579; rPFS: HR 1.82, 95% CI 0.60-5.47, P = 0.1641). URS conferred superior renal function preservation. In patients characterized by factors such as radiographically invisible lesions, negative cytology, pTa stage, low-grade tumors, and multiple lesions, the OS outcomes with URS were comparable to those with RNU as follows: radiographically invisible lesions (P = 0.5768), negative cytology (P = 0.7626), pTa stage (P = 0.6694), low-grade tumors (P = 0.9870), and multiple lesions (P = 0.8586).
URS offers survival outcomes similar to RNU, along with better renal function preservation, especially in low-risk UTUC patients. These findings underscore the urgency of re-evaluating the current EAU guidelines and encourage further research into determining the ideal patient selection for URS in UTUC treatment.

© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Author

admin

View all posts

ABOUT THE EXPERTS

Takuya Tsujino,Kazumasa Komura,Teruo Inamoto,Ryoichi Maenosono,Takeshi Hashimoto,Takahiro Adachi,Yosuke Hirasawa,Satoshi Tokushige,Takaya Ohno,Shogo Yamazaki,Tatsuo Fukushima,Ko Nakamura,Yusuke Yano,Kazuki Nishimura,Shoko Kinoshita,Keita Nakamori,Takeshi Tsutsumi,Tomohisa Matsunaga,Yuki Yoshikawa,Taizo Uchimoto,Tomoaki Takai,Koichiro Minami,Hirofumi Uehara,Hajime Hirano,Hayahito Nomi,Kiyoshi Takahara,Yoshio Ohno,Haruhito Azuma

Takuya Tsujino

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan. takuya.tsujino@ompu.ac.jp.

Kazumasa Komura

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Translational Research Program, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Teruo Inamoto

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Ryoichi Maenosono

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Takeshi Hashimoto

Department of Urology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.

Takahiro Adachi

Department of Urology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.

Yosuke Hirasawa

Department of Urology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.

Satoshi Tokushige

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Takaya Ohno

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Shogo Yamazaki

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Tatsuo Fukushima

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Ko Nakamura

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Yusuke Yano

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Kazuki Nishimura

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Shoko Kinoshita

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Keita Nakamori

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Takeshi Tsutsumi

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Tomohisa Matsunaga

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Yuki Yoshikawa

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Taizo Uchimoto

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Tomoaki Takai

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Koichiro Minami

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Hirofumi Uehara

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Hajime Hirano

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Hayahito Nomi

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Kiyoshi Takahara

Department of Urology, Fujita-Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.

Yoshio Ohno

Translational Research Program, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

Haruhito Azuma

Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.