Comparative analysis of oncologic outcomes of partial ureterectomy vs radical nephroureterectomy in upper tract urothelial carcinoma

Aditya Bagrodia, Franklin E. Kuehhas, Bishoy A. Gayed, Christopher G. Wood, Jay Raman, Payal Kapur, Ithaar H. Derweesh, Karim Bensalah, Arthur I. Sagalowsky, Shahrokh F. Shariat, Yair Lotan, Vitaly Margulis

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Abstract

Objective: To compare oncologic outcomes in an international cohort of patients who underwent either partial ureterectomy (PU) or radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods: A subgroup of patients from the UTUC Collaboration with operation classified as PU or RNU was used (n = 835). Clinicopathologic outcomes were evaluated. Survival was assessed using the Kaplan-Meier method. Cox regression addressed recurrence-free survival (RFS) and cancer-specific survival (CSS). Results: Median age and follow-up were 69 years (range 32-97 years) and 34 months (range 1-246 months), respectively. Relapse occurred in 28.5% of patients (19.6% local, 8.9% systemic). At analysis, 180 patients (21.6%) died of UTUC. Eighty-one patients (9.7%) underwent PU and 754 (90.3%) underwent RNU. High tumor grade (77.3% vs 55.6%, P <.001) and advanced T stage (>T1, 41.7% vs 30.9%, P <.001) were significantly more common in the RNU cohort. Significantly more patients in the PU group received adjuvant chemotherapy than the RNU arm (25.9% vs 16.8%, respectively, P =.05). Kaplan-Meier median 5-year survival probabilities for RFS (69.4% vs 75.9%, P =.06) and CSS (67.5% vs 72.1%, P =.06) were not significantly different between PU and RNU. On multivariable analysis, Eastern Cooperative Oncology Group (ECOG) performance status, tumor stage, tumor necrosis, and lymph node (LN) status were significantly associated with CSS. Conclusion: In patients with UTUC, PU seems to provide oncologic efficacy equal to RNU. Ability to maximize global renal function with utilization of PU is an attractive strategy in carefully selected patients.

Original languageEnglish (US)
Pages (from-to)972-978
Number of pages7
JournalUrology
Volume81
Issue number5
DOIs
StatePublished - Jan 1 2013

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Carcinoma
Survival
Neoplasms
Recurrence
Adjuvant Chemotherapy
Necrosis
Lymph Nodes
Kidney

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Bagrodia, Aditya ; Kuehhas, Franklin E. ; Gayed, Bishoy A. ; Wood, Christopher G. ; Raman, Jay ; Kapur, Payal ; Derweesh, Ithaar H. ; Bensalah, Karim ; Sagalowsky, Arthur I. ; Shariat, Shahrokh F. ; Lotan, Yair ; Margulis, Vitaly. / Comparative analysis of oncologic outcomes of partial ureterectomy vs radical nephroureterectomy in upper tract urothelial carcinoma. In: Urology. 2013 ; Vol. 81, No. 5. pp. 972-978.
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title = "Comparative analysis of oncologic outcomes of partial ureterectomy vs radical nephroureterectomy in upper tract urothelial carcinoma",
abstract = "Objective: To compare oncologic outcomes in an international cohort of patients who underwent either partial ureterectomy (PU) or radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods: A subgroup of patients from the UTUC Collaboration with operation classified as PU or RNU was used (n = 835). Clinicopathologic outcomes were evaluated. Survival was assessed using the Kaplan-Meier method. Cox regression addressed recurrence-free survival (RFS) and cancer-specific survival (CSS). Results: Median age and follow-up were 69 years (range 32-97 years) and 34 months (range 1-246 months), respectively. Relapse occurred in 28.5{\%} of patients (19.6{\%} local, 8.9{\%} systemic). At analysis, 180 patients (21.6{\%}) died of UTUC. Eighty-one patients (9.7{\%}) underwent PU and 754 (90.3{\%}) underwent RNU. High tumor grade (77.3{\%} vs 55.6{\%}, P <.001) and advanced T stage (>T1, 41.7{\%} vs 30.9{\%}, P <.001) were significantly more common in the RNU cohort. Significantly more patients in the PU group received adjuvant chemotherapy than the RNU arm (25.9{\%} vs 16.8{\%}, respectively, P =.05). Kaplan-Meier median 5-year survival probabilities for RFS (69.4{\%} vs 75.9{\%}, P =.06) and CSS (67.5{\%} vs 72.1{\%}, P =.06) were not significantly different between PU and RNU. On multivariable analysis, Eastern Cooperative Oncology Group (ECOG) performance status, tumor stage, tumor necrosis, and lymph node (LN) status were significantly associated with CSS. Conclusion: In patients with UTUC, PU seems to provide oncologic efficacy equal to RNU. Ability to maximize global renal function with utilization of PU is an attractive strategy in carefully selected patients.",
author = "Aditya Bagrodia and Kuehhas, {Franklin E.} and Gayed, {Bishoy A.} and Wood, {Christopher G.} and Jay Raman and Payal Kapur and Derweesh, {Ithaar H.} and Karim Bensalah and Sagalowsky, {Arthur I.} and Shariat, {Shahrokh F.} and Yair Lotan and Vitaly Margulis",
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Bagrodia, A, Kuehhas, FE, Gayed, BA, Wood, CG, Raman, J, Kapur, P, Derweesh, IH, Bensalah, K, Sagalowsky, AI, Shariat, SF, Lotan, Y & Margulis, V 2013, 'Comparative analysis of oncologic outcomes of partial ureterectomy vs radical nephroureterectomy in upper tract urothelial carcinoma', Urology, vol. 81, no. 5, pp. 972-978. https://doi.org/10.1016/j.urology.2012.12.059

Comparative analysis of oncologic outcomes of partial ureterectomy vs radical nephroureterectomy in upper tract urothelial carcinoma. / Bagrodia, Aditya; Kuehhas, Franklin E.; Gayed, Bishoy A.; Wood, Christopher G.; Raman, Jay; Kapur, Payal; Derweesh, Ithaar H.; Bensalah, Karim; Sagalowsky, Arthur I.; Shariat, Shahrokh F.; Lotan, Yair; Margulis, Vitaly.

In: Urology, Vol. 81, No. 5, 01.01.2013, p. 972-978.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparative analysis of oncologic outcomes of partial ureterectomy vs radical nephroureterectomy in upper tract urothelial carcinoma

AU - Bagrodia, Aditya

AU - Kuehhas, Franklin E.

AU - Gayed, Bishoy A.

AU - Wood, Christopher G.

AU - Raman, Jay

AU - Kapur, Payal

AU - Derweesh, Ithaar H.

AU - Bensalah, Karim

AU - Sagalowsky, Arthur I.

AU - Shariat, Shahrokh F.

AU - Lotan, Yair

AU - Margulis, Vitaly

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Objective: To compare oncologic outcomes in an international cohort of patients who underwent either partial ureterectomy (PU) or radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods: A subgroup of patients from the UTUC Collaboration with operation classified as PU or RNU was used (n = 835). Clinicopathologic outcomes were evaluated. Survival was assessed using the Kaplan-Meier method. Cox regression addressed recurrence-free survival (RFS) and cancer-specific survival (CSS). Results: Median age and follow-up were 69 years (range 32-97 years) and 34 months (range 1-246 months), respectively. Relapse occurred in 28.5% of patients (19.6% local, 8.9% systemic). At analysis, 180 patients (21.6%) died of UTUC. Eighty-one patients (9.7%) underwent PU and 754 (90.3%) underwent RNU. High tumor grade (77.3% vs 55.6%, P <.001) and advanced T stage (>T1, 41.7% vs 30.9%, P <.001) were significantly more common in the RNU cohort. Significantly more patients in the PU group received adjuvant chemotherapy than the RNU arm (25.9% vs 16.8%, respectively, P =.05). Kaplan-Meier median 5-year survival probabilities for RFS (69.4% vs 75.9%, P =.06) and CSS (67.5% vs 72.1%, P =.06) were not significantly different between PU and RNU. On multivariable analysis, Eastern Cooperative Oncology Group (ECOG) performance status, tumor stage, tumor necrosis, and lymph node (LN) status were significantly associated with CSS. Conclusion: In patients with UTUC, PU seems to provide oncologic efficacy equal to RNU. Ability to maximize global renal function with utilization of PU is an attractive strategy in carefully selected patients.

AB - Objective: To compare oncologic outcomes in an international cohort of patients who underwent either partial ureterectomy (PU) or radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods: A subgroup of patients from the UTUC Collaboration with operation classified as PU or RNU was used (n = 835). Clinicopathologic outcomes were evaluated. Survival was assessed using the Kaplan-Meier method. Cox regression addressed recurrence-free survival (RFS) and cancer-specific survival (CSS). Results: Median age and follow-up were 69 years (range 32-97 years) and 34 months (range 1-246 months), respectively. Relapse occurred in 28.5% of patients (19.6% local, 8.9% systemic). At analysis, 180 patients (21.6%) died of UTUC. Eighty-one patients (9.7%) underwent PU and 754 (90.3%) underwent RNU. High tumor grade (77.3% vs 55.6%, P <.001) and advanced T stage (>T1, 41.7% vs 30.9%, P <.001) were significantly more common in the RNU cohort. Significantly more patients in the PU group received adjuvant chemotherapy than the RNU arm (25.9% vs 16.8%, respectively, P =.05). Kaplan-Meier median 5-year survival probabilities for RFS (69.4% vs 75.9%, P =.06) and CSS (67.5% vs 72.1%, P =.06) were not significantly different between PU and RNU. On multivariable analysis, Eastern Cooperative Oncology Group (ECOG) performance status, tumor stage, tumor necrosis, and lymph node (LN) status were significantly associated with CSS. Conclusion: In patients with UTUC, PU seems to provide oncologic efficacy equal to RNU. Ability to maximize global renal function with utilization of PU is an attractive strategy in carefully selected patients.

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