Mp38-01 Oncological Outcomes and Preoperative Predictors of Disease Recurrence in Upper Tract Urothelial Carcinoma Patients Treated With Distal Ureterectomy: Results From a Large National Cohort

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP38)1 May 2024MP38-01 ONCOLOGICAL OUTCOMES AND PREOPERATIVE PREDICTORS OF DISEASE RECURRENCE IN UPPER TRACT UROTHELIAL CARCINOMA PATIENTS TREATED WITH DISTAL URETERECTOMY: RESULTS FROM A LARGE NATIONAL COHORT Matteo Rosazza, Francesco Soria, Simone Livoti, Daniele Dutto, Fulvia Colucci, Elisa De Lorenzis, Nazario Foschi, Guglielmo Mantica, Francesca Ambrosini, Riccardo Campi, Sergio Serni, Luisa Moscardi, Francesco Chiancone, Daniele Amparore, Giuseppe Lucarelli, Francesco Lasorsa, and Paolo Gontero Matteo RosazzaMatteo Rosazza , Francesco SoriaFrancesco Soria , Simone LivotiSimone Livoti , Daniele DuttoDaniele Dutto , Fulvia ColucciFulvia Colucci , Elisa De LorenzisElisa De Lorenzis , Nazario FoschiNazario Foschi , Guglielmo ManticaGuglielmo Mantica , Francesca AmbrosiniFrancesca Ambrosini , Riccardo CampiRiccardo Campi , Sergio SerniSergio Serni , Luisa MoscardiLuisa Moscardi , Francesco ChianconeFrancesco Chiancone , Daniele AmparoreDaniele Amparore , Giuseppe LucarelliGiuseppe Lucarelli , Francesco LasorsaFrancesco Lasorsa , and Paolo GonteroPaolo Gontero View All Author Informationhttps://doi.org/10.1097/01.JU.0001008700.92603.b1.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Distal ureterectomy (DU) is a treatment option for patients with low-risk Upper Tract Urothelial Carcinoma (UTUC), as well as for selected high-risk patients. However, the indications for DU in UTUC patients remain unclear. We therefore aimed to evaluate oncological outcomes and predictors of disease recurrence in patients with UTUC of the pelvic ureter treated with DU. METHODS: This was a multicenter retrospective collaboration involving 8 Italian referral centers. Patients with UTUC in the pelvic ureter treated with DU with or without lymph node dissection (LND) between 2010 and 2023 were included. The primary endpoint was 5-year recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS), as well as intravesical recurrence-free (IVRFS) and homolateral urinary tract recurrence-free (HUTRFS) survival as secondary endpoints. Multivariable Cox regression analyses were performed to evaluate the impact of standard prognosticators used in the risk-stratification model on disease recurrence. RESULTS: Overall, 129 patients were included. Among them, 54 (42%) were deemed to have low-risk UTUC while 75 (58%) high-risk disease based on the EAU risk-stratification model. An open, laparoscopic or robotic approach was used in 119 (92%), 4 (2%) and 6 (6%) patients, respectively. An extravesical, intravesical or endoscopic approach for bladder cuff management was performed in 50 (39%), 77 (60%) and 2 (1%), respectively. LND was performed in 65 (50%) patients. Median follow up was 40 months (IQRs 13-59). 5-yrs RFS, CSS and OS were 87.5%, 91.3% and 71.1%, respectively. IVRFS and HUTRFS were 47% and 80.5%, respectively. High-risk patients were at higher risk of developing disease recurrence (HR 7.5, p=0.05) compared to low-risk patients; however, this did not translate into impaired CSS and OS. At multivariable cox-regression analyses, high-grade disease and tumor size were associated with disease recurrence (all p<0.05), while multifocality was associated with HUT recurrence (p=0.009). No association with CSS or OS has been detected. CONCLUSIONS: In low-risk and selected high-risk UTUC patients DU should be considered a valid alternative to radical nephroureterectomy (RNU). However, caution is warranted when high-grade disease is identified at the time of ureteroscopic biopsy due to an increased risk of disease recurrence. Additionally, patients with multifocal disease are at an increased risk of HUT recurrence and may benefit from more intensive endoscopic follow-up. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e640 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Matteo Rosazza More articles by this author Francesco Soria More articles by this author Simone Livoti More articles by this author Daniele Dutto More articles by this author Fulvia Colucci More articles by this author Elisa De Lorenzis More articles by this author Nazario Foschi More articles by this author Guglielmo Mantica More articles by this author Francesca Ambrosini More articles by this author Riccardo Campi More articles by this author Sergio Serni More articles by this author Luisa Moscardi More articles by this author Francesco Chiancone More articles by this author Daniele Amparore More articles by this author Giuseppe Lucarelli More articles by this author Francesco Lasorsa More articles by this author Paolo Gontero More articles by this author Expand All Advertisement PDF downloadLoading ...