Decisional and prognostic impact of diagnostic ureteroscopy in high-risk upper tract urothelial carcinoma: A multi-institutional collaborative analysis (ROBUUST collaborative group).

Autor: Ditonno F; University of Verona, Department of Urology, Verona, Italy; Rush University, Department of Urology, Chicago, IL., Franco A; Rush University, Department of Urology, Chicago, IL; Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy., Veccia A; University of Verona, Department of Urology, Verona, Italy., Bertolo R; University of Verona, Department of Urology, Verona, Italy., Wu Z; Changhai Hospital Naval Medical University, Department of Urology, Shanghai, China., Wang L; Changhai Hospital Naval Medical University, Department of Urology, Shanghai, China., Abdollah F; Henry Ford Hospital, Vattikuti Urology Institute, Detroit, MI., Finati M; Henry Ford Hospital, Vattikuti Urology Institute, Detroit, MI., Simone G; IRCCS Regina Elena National Cancer Institute, Department of Urology, Rome, Italy., Tuderti G; IRCCS Regina Elena National Cancer Institute, Department of Urology, Rome, Italy., Helstrom E; Fox Chase Cancer Center, Department of Urology, Philadelphia, PA., Correa A; Fox Chase Cancer Center, Department of Urology, Philadelphia, PA., De Cobelli O; European Institute of Oncology IRCCS, Division of Urology, Milan, Italy., Ferro M; European Institute of Oncology IRCCS, Division of Urology, Milan, Italy., Porpiglia F; University of Turin San Luigi Gonzaga Hospital, Division of Urology, Turin, Italy., Amparore D; University of Turin San Luigi Gonzaga Hospital, Division of Urology, Turin, Italy., Tufano A; Istituto Nazionale Tumori Fondazione Pascale, Department of Urology, Naples, Italy., Perdonà S; Istituto Nazionale Tumori Fondazione Pascale, Department of Urology, Naples, Italy., Bhanvadia R; University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX., Margulis V; University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX., Brönimann S; John Hopkins University, The James Buchanan Brady Urological Institute, Baltimore, MD., Singla N; John Hopkins University, The James Buchanan Brady Urological Institute, Baltimore, MD., Puri D; UC San Diego School of Medicine, Department of Urology, La Jolla, CA., Derweesh IH; UC San Diego School of Medicine, Department of Urology, La Jolla, CA., Mendiola DF; University of Miami Miller School of Medicine, Desai Sethi Urology Institute, Miami, FL., Gonzalgo ML; University of Miami Miller School of Medicine, Desai Sethi Urology Institute, Miami, FL., Ben-David R; Icahn School of Medicine at Mount Sinai Hospital, Department of Urology, New York, NY., Mehrazin R; Icahn School of Medicine at Mount Sinai Hospital, Department of Urology, New York, NY., Moon SC; Department of Urology, University of Alabama, Heersink School of Medicine, Birmingham, AL., Rais-Bahrami S; Department of Urology, University of Alabama, Heersink School of Medicine, Birmingham, AL., Yong C; Indiana University, Department of Urology, Indianapolis, IN., Sundaram CP; Indiana University, Department of Urology, Indianapolis, IN., Moghaddam FS; Norris Comprehensive Cancer Center University of Southern California, Institute of Urology, Los Angeles, CA., Ghoreifi A; Norris Comprehensive Cancer Center University of Southern California, Institute of Urology, Los Angeles, CA., Djaladat H; Norris Comprehensive Cancer Center University of Southern California, Institute of Urology, Los Angeles, CA., Autorino R; Rush University, Department of Urology, Chicago, IL., Antonelli A; University of Verona, Department of Urology, Verona, Italy. Electronic address: alessandro.antonelli@univr.it.
Jazyk: angličtina
Zdroj: Urologic oncology [Urol Oncol] 2024 Sep; Vol. 42 (9), pp. 290.e1-290.e9. Date of Electronic Publication: 2024 May 17.
DOI: 10.1016/j.urolonc.2024.04.021
Abstrakt: Background: Diagnostic ureteroscopy (URS) with or without biopsy remains a subject of contention in the management of upper tract urothelial carcinoma (UTUC), with varying recommendations across different guidelines. The study aims to analyse the decision-making and prognostic role of diagnostic ureteroscopy (URS) in high-risk UTUC patients undergoing curative surgery.
Materials and Methods: In this retrospective multi-institutional analysis of high-risk UTUC patients from the ROBUUST dataset, a comparison between patients who received or not preoperative URS and biopsy before curative surgery was carried out. Logistic regression analysis evaluated differences between patients receiving URS and its impact on treatment strategy. Survival analysis 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 group features, Cox proportional hazard model estimated significant predictors of time-to-event outcomes.
Results: Overall, 1,912 patients were included, 1,035 with preoperative URS and biopsy and 877 without. Median follow-up: 24 months. Robot-assisted radical nephroureterectomy was the most common procedure (55.1%), in both subgroups. The 5-year OS (P = 0.04) and CSS (P < 0.001) were significantly higher for patients undergoing URS. The 5-year RFS (P = 0.6), and MFS (P = 0.3) were comparable between the 2 groups. Preoperative URS and biopsy were neither a significant predictor of worse oncological outcomes nor of a specific treatment modality.
Conclusions: The advantage in terms of OS and CSS in patients undergoing preoperative URS could derive from a better selection of candidates for curative treatment. The treatment strategy is likely more influenced by tumor features than by URS findings.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: