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Oncological outcomes of radical nephroureterectomy versus kidney-sparing surgery for elective treatment of clinically organ-confined upper tract urothelial carcinoma of the distal ureter

Abstract : Purpose To compare the oncological outcomes of radical nephroureterectomy (RNU), distal ureterectomy (DU), and endoscopic surgery (ENDO) for elective treatment of clinically organ-confined upper tract urothelial carcinoma (UTUC) of the distal ureter. Material & Methods From a multi-institutional collaborative database, we identified 304 patients with unifocal clinically organ-confined UTUC of the distal ureter and bilateral functional kidneys. Overall survival (OS), cancer-specific survival (CSS), local recurrence-free survival (LRFS), and intravesical recurrence-free survival (IVRFS), according to the surgery type, were compared using Kaplan–Meier statistics. Univariable and multivariable Cox regression analyses were performed to assess the adjusted outcomes of RNU, DU, and ENDO. Results Overall, 128 (42.1%), 134 (44.1%), and 42 (13.8%) patients were treated with RNU, DU, and ENDO, respectively. Although OS, CSS, and IVRFS were equivalent between the three surgical procedures, the 5-year LRFS rate was lower in the ENDO group (35.7%) when compared to RNU (95.0%; p<0.001) or DU (85.5%; p=0.01), with no significant difference between RNU and DU. In multivariable analyses, only ENDO was an independent predictor of decreased LRFS when compared to RNU (HR=0.79; p=0.001) or DU (HR=0.88; p=0.01), whereas both DU and ENDO were not significantly correlated to CSS or IVRFS. However, when adjustment was made for ASA score, DU (HR=1.25; p=0.01) and ENDO (HR=1.19; p=0.02) were independent predictors of increased OS, although no significant difference was found between them. Conclusion Because of better oncological outcomes, DU could be considered as the first-line treatment for elective treatment of clinically organ-confined UTUC of the distal ureter
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https://hal-univ-rennes1.archives-ouvertes.fr/hal-01240470
Contributor : Laurent Jonchère <>
Submitted on : Wednesday, December 9, 2015 - 11:43:11 AM
Last modification on : Wednesday, August 19, 2020 - 11:18:09 AM

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Thomas Seisen, Laurent Nison, Mezut Remzi, Tobias Klatte, Romain Mathieu, et al.. Oncological outcomes of radical nephroureterectomy versus kidney-sparing surgery for elective treatment of clinically organ-confined upper tract urothelial carcinoma of the distal ureter. Journal of Urology, Elsevier, 2016, 195 (5), pp.1354-1361. ⟨10.1016/j.juro.2015.11.036⟩. ⟨hal-01240470⟩

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