MP69-10 SURVIVAL CONSEQUENCES OF OMITTING BLADDER CUFF DURING NEPHROURETERECTOMY FOR LOCALIZED UPPER TRACT UROTHELIAL CARCINOMA

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP69-10 SURVIVAL CONSEQUENCES OF OMITTING BLADDER CUFF DURING NEPHROURETERECTOMY FOR LOCALIZED UPPER TRACT UROTHELIAL CARCINOMA Mohammad Mahmoud, Ryan Wong, Awais Paracha, Zohair Siddiqui, Isamu Tachibana, Zachary Hamilton, Sameer Siddiqui, and Hristos Kaimakliotis Mohammad MahmoudMohammad Mahmoud More articles by this author , Ryan WongRyan Wong More articles by this author , Awais ParachaAwais Paracha More articles by this author , Zohair SiddiquiZohair Siddiqui More articles by this author , Isamu TachibanaIsamu Tachibana More articles by this author , Zachary HamiltonZachary Hamilton More articles by this author , Sameer SiddiquiSameer Siddiqui More articles by this author , and Hristos KaimakliotisHristos Kaimakliotis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical nephroureterectomy with bladder cuff resection (NU) is commonly performed for eligible patients with localized upper tract urothelial carcinoma (UTUC). NU with simultaneous resection of bladder cuff around the ipsilateral ureteral orifice (NU+Cuff) is recommended for high grade (HG) tumors in the current NCCN and EAU guidelines. Objective: To determine survival outcomes of sparing bladder cuff during nephroureterectomy (NU-) in real world data from contemporary US population registry. METHODS: Using the National Cancer Database, we selected patients with localized UTUC (pT≤3 pN0 pM0), who had either NU- or NU+Cuff between 2004 and 2018. To concentrate on surgical survival, those with perioperative chemotherapy, immunotherapy, or radiation were excluded. Propensity scores were calculated by logistic regression model to account for heterogeneous patients and tumor characteristics thus controlling for inherited selection bias in retrospective design. The two groups’ survival outcomes were compared by Kaplan-Meier method, log rank test, and Cox proportional hazards models adjusted via propensity scores weighted analyses. RESULTS: There were a total of 35,854 patients (6,488 in NU- group and 29,366 in NU+Cuff group). Patients who had NU+Cuff had higher median survival (82.49 vs 68.64 mo; p<0.0001) and better overall survival (HR=0.89, [0.85, 0.94] p<0.001). In high grade (HG) tumors, 3577 patients had NU- and 14,989 had NU+Cuff. In low grade (LG), 1705 patients had NU- and 8761 had NU+Cuff. The NU+Cuff group had higher median survival in HG (63.58 vs 55.72 mo, p=0.007), but not in LG (113.02 vs 100.37 mo, p=0.21). CONCLUSIONS: About 20% of patients with localized UTUC are managed with bladder cuff sparing surgery. However, NU+Cuff carries survival advantage with HG-UTUC irrespective of patient and tumor characteristics. Omitting bladder cuff resection during NU in patients with LG-UTUC does not affect survival benefit. Source of Funding: Saint Louis University and Indiana University © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e967 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohammad Mahmoud More articles by this author Ryan Wong More articles by this author Awais Paracha More articles by this author Zohair Siddiqui More articles by this author Isamu Tachibana More articles by this author Zachary Hamilton More articles by this author Sameer Siddiqui More articles by this author Hristos Kaimakliotis More articles by this author Expand All Advertisement PDF downloadLoading ...