Comparison of oncologic and functional outcomes between radical nephroureterectomy and segmental ureterectomy for upper urinary tract urothelial carcinoma

Seong Il Seo,Minyong Kang,Hyun Moo Lee,Tae Heon Kim,Byong Chang Jeong,Seong Soo Jeon,Hwang Gyun Jeon,Hyun Hwan Sung,Chung Un Lee

doi:10.1038/s41598-021-87573-5

Abstract

This study aims to compare oncologic and functional outcomes after radical nephroureterectomy (RNU) and segmental ureterectomy (SU) in patients with upper urinary tract urothelial carcinoma (UTUC). We retrospectively collected data on patients who underwent either RNU or SU of UTUC. Propensity score matching was performed among 394 cases to yield a final cohort of 40 RNU and 40 SU cases. Kaplan–Meier analysis and the log-rank test were used to compare overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), and intravesical recurrence-free survival (IVRFS) between the groups. We also compared the change in postoperative estimated glomerular filtration rate (eGFR). There was no significant difference in terms of CSS, PFS, and IVRFS between the RNU and SU groups, but the RNU group had a better OS than the SU group (p = 0.032). Postoperative eGFR was better preserved in the SU group than in the RNU group (p < 0.001). SU provides comparable CSS, PFS, and IVRFS for patients with UTUC compared to RNU, even in patients with advanced-stage and/or high-grade cancer. Further, SU achieves better preservation of renal function.

Highlights

This study aims to compare oncologic and functional outcomes after radical nephroureterectomy (RNU) and segmental ureterectomy (SU) in patients with upper urinary tract urothelial carcinoma (UTUC)
Radical nephroureterectomy (RNU) with bladder cuff excision has been the gold-standard for management of non-metastatic UTUC, the resultant solitary kidney status may lead to higher rates of surgically induced renal insufficiency, dialysis, cardiovascular morbidity, and overall m ortality[4,5,6,7,8]
Patients treated with SU had significantly better preservation of renal function than the those treated with RNU both 1 month and 1 year postoperatively. In this propensity matched comparison, we found that SU and RNU offer equivalent 3-year cancer-specific survival (CSS), progression-free survival (PFS), and intravesical recurrence-free survival (IVRFS) in patients with non-metastatic UTUC, and that renal function was better preserved in patients treated with SU compared with RNU

Summary

Introduction

This study aims to compare oncologic and functional outcomes after radical nephroureterectomy (RNU) and segmental ureterectomy (SU) in patients with upper urinary tract urothelial carcinoma (UTUC). SU provides comparable CSS, PFS, and IVRFS for patients with UTUC compared to RNU, even in patients with advanced-stage and/or high-grade cancer. Despite the putative advantages of SU over RNU, little is known about whether SU contributes to better preservation of renal function while. Due to the lack of high-quality randomized studies focused on oncologic and functional outcomes of SU, we aimed to clarify the potential therapeutic benefit of SU. To address this unmet issue, we compared oncologic control and renal function recovery of patients that underwent SU and RNU

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Conclusion