Bladder cuff excision at radical nephroureterectomy improved survival in upper tract urothelial carcinoma

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations Pub Date : 2025-03-20 DOI:10.1016/j.urolonc.2025.02.014

Francesco Di Bello , Carolin Siech , Mario de Angelis , Natali Rodriguez Peñaranda , Letizia Maria Ippolita Jannello , Zhe Tian , Jordan A. Goyal , Claudia Collà Ruvolo , Gianluigi Califano , Francesco Mangiapia , Fred Saad , Shahrokh F. Shariat , Ottavio de Cobelli , Alberto Briganti , Felix K.H. Chun , Salvatore Micali , Nicola Longo , Pierre I. Karakiewicz

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引用次数: 0

Abstract

Objective

To test for survival differences after radical nephroureterectomy (RNU) in pT1-T3N0 upper tract urothelial carcinoma (UTUC) patients according to bladder cuff excision (BCE) status.

Methods

Within the Surveillance, Epidemiology, and End Results database (2004–2020), we identified RNU patients and documented BCE status. Prior and after propensity score matching (ratio 1:1), cumulative incidence plots and competing risk regression (CRR) models addressed cancer specific mortality (CSM) and other-cause mortality (OCM).

Results

Of 4,426 RNU-treated patients, 3,186 (72%) patients underwent BCE and 1,240 (28%) did not. BCE rates significantly increased over time from 65.2 to 77.0% (EAPC: +1.0%, 95% CI +0.4 to +1.6%, P = 0.004) between 2004 and 2020. After 1:1 propensity score matching for T stage, 1,240 of 1,240 (100%) RNU patients without BCE and 1,240 of 3,186 (39%) RNU patients with BCE were included in subsequent analyses. Five-year CSM rates were 30% in RNU with BCE vs. 36% in RNU without BCE patients (Δ = 6%). In multivariable CRR, RNU with BCE independently predicted lower CSM (HR: 0.81, 95% CI: 0.70–0.93; P < 0.001). Conversely, BCE status did not affect OCM (P = 0.4).

Conclusion

The rate of guideline recommended BCE at RNU increased over time. Additionally, RNU with BCE is associated with significantly lower CSM than RNU without BCE in pT1-T3N0 UTUC patients. In consequence, BCE should represent an integral part of a comprehensive RNU.

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根治性肾输尿管切除术中膀胱袖切除可提高上尿路上皮癌患者的生存率。

目的：探讨pT1-T3N0上路尿路上皮癌（UTUC）患者膀胱袖带切除（BCE）情况对根治性肾输尿管切除术（RNU）后生存率的影响。方法：在监测、流行病学和最终结果数据库（2004-2020）中，我们确定了RNU患者并记录了BCE状态。前后倾向评分匹配（比例1:1），累积发生率图和竞争风险回归（CRR）模型解决了癌症特异性死亡率（CSM）和其他原因死亡率（OCM）。结果：在4426例rnu治疗的患者中，3186例（72%）患者接受了BCE治疗，1240例（28%）患者未接受BCE治疗。从2004年到2020年，BCE率从65.2显著增加到77.0% （EAPC: +1.0%, 95% CI +0.4至+1.6%,P = 0.004）。在对T期进行1:1倾向评分匹配后，1240例（100%）无BCE的RNU患者中的1240例和3186例（39%）有BCE的RNU患者中的1240例被纳入后续分析。合并BCE的RNU患者5年CSM率为30%，未合并BCE的RNU患者为36% （Δ = 6%）。在多变量CRR中，RNU与BCE独立预测较低的CSM (HR: 0.81, 95% CI: 0.70-0.93；P 结论：RNU指南推荐的BCE率随着时间的推移而增加。此外，在pT1-T3N0 UTUC患者中，伴有BCE的RNU与无BCE的RNU相比，CSM显著降低。因此，BCE应该是综合RNU的一个组成部分。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urologic Oncology-seminars and Original Investigations 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.70%

发文量

297

审稿时长

7.6 weeks

期刊介绍： Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.