Abstract
Background
Oncologic benefits of laparoscopic radical nephroureterectomy (LNU) are unclear. We aimed to evaluate the impact of surgical approach for radical nephroureterectomy on oncologic outcomes in patients with locally advanced upper tract urothelial carcinoma (UTUC).
Methods
Of 426 patients who underwent radical nephroureterectomy at five medical centers between February 1995 and February 2017, we retrospectively investigated oncological outcomes in 229 with locally advanced UTUC (stages cT3-4 and/or cN+). The surgical approach was classified as open nephroureterectomy (ONU) or LNU, and oncologic outcomes, including intravesical recurrence-free survival (RFS), visceral RFS, cancer-specific survival (CSS), and overall survival (OS), were compared between the groups. The inverse probability of treatment weighting (IPTW)-adjusted Cox-regression analyses was performed to evaluate the impact of LNU on the prognosis.
Results
Of the 229 patients, 48 (21%) underwent LNU. There were significant differences in patient backgrounds, including preoperative renal function, lymph-node involvement, lymphovascular invasion, and surgical margins, between the groups. Before the background adjustment, intravesical RFS, visceral RFS, CSS, and OS were significantly inferior in the ONU group than in the LNU group. However, in the IPTW-adjusted Cox-regression analysis, no significant differences were observed in intravesical RFS (hazard ratio [HR], 0.65; P = 0.476), visceral RFS (HR, 0.46; P = 0.109), CSS (HR, 0.48; P = 0.233), and OS (HR, 0.40; P = 0.147).
Conclusion
Surgical approaches were not independently associated with prognosis in patients with locally advanced UTUC.
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Abbreviations
- UTUC:
-
Upper tract urothelial carcinoma
- ONU:
-
Open radical nephroureterectomy
- LNU:
-
Laparoscopic radical nephroureterectomy
- IPTW:
-
Inverse probability of treatment weighting
- ECOG-PS:
-
Eastern Cooperative Oncology Group performance status
- HTN:
-
Hypertension
- CVD:
-
Cardiovascular disease
- DM:
-
Diabetes mellitus
- eGFR:
-
Estimated glomerular filtration rate
- CKD:
-
Chronic kidney disease
- NAC:
-
Neoadjuvant chemotherapy
- LVI:
-
Lymphovascular invasion
- RFS:
-
Recurrence-free survival
- CSS:
-
Cancer-specific survival
- OS:
-
Overall survival
- HR:
-
Hazard ratio
- CI:
-
Confidence interval
References
Roupret M, Babjuk M, Comperat E et al (2015) European Association of Urology Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma: 2015 Update. Eur Urol 68(5):868–879. https://doi.org/10.1016/j.eururo.2015.06.044
Miyazaki J, Nishiyama H, Fujimoto H et al (2016) Laparoscopic versus open nephroureterectomy in muscle-invasive upper tract urothelial carcinoma: subanalysis of the Multi-Institutional National Database of the Japanese Urological Association. J Endourol 30(5):520–525. https://doi.org/10.1089/end.2015.0757
Capitanio U, Shariat SF, Isbarn H et al (2009) Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy: a multi-institutional analysis of 1249 cases. Eur Urol 56(1):1–9. https://doi.org/10.1016/j.eururo.2009.03.072
Simone G, Papalia R, Guaglianone S et al (2009) Laparoscopic versus open nephroureterectomy: perioperative and oncologic outcomes from a randomised prospective study. Eur Urol 56(3):520–526. https://doi.org/10.1016/j.eururo.2009.06.013
Ariane MM, Colin P, Ouzzane A et al (2012) Assessment of oncologic control obtained after open versus laparoscopic nephroureterectomy for upper urinary tract urothelial carcinomas (UUT-UCs): results from a large French multicenter collaborative study. Ann Surg Oncol 19(1):301–308. https://doi.org/10.1245/s10434-011-1841-x
Ni S, Tao W, Chen Q et al (2012) Laparoscopic versus open nephroureterectomy for the treatment of upper urinary tract urothelial carcinoma: a systematic review and cumulative analysis of comparative studies. Eur Urol 61(6):1142–1153. https://doi.org/10.1016/j.eururo.2012.02.019
Fairey AS, Kassouf W, Estey E et al (2013) Comparison of oncological outcomes for open and laparoscopic radical nephroureterectomy: results from the Canadian Upper Tract Collaboration. BJU Int 112(6):791–797. https://doi.org/10.1111/j.1464-410X.2012.11474.x
Zhang S, Luo Y, Wang C et al (2016) Long-term oncologic outcomes of laparoscopic nephroureterectomy versus open nephroureterectomy for upper tract urothelial carcinoma: a systematic review and meta-analysis. PeerJ 4:e2063. https://doi.org/10.7717/peerj.2063
Kamihira O, Hattori R, Yamaguchi A et al (2009) Laparoscopic radical nephroureterectomy: a multicenter analysis in Japan. Eur Urol 55(6):1397–1407. https://doi.org/10.1016/j.eururo.2009.03.003
Kim HS, Ku JH, Jeong CW et al (2016) Laparoscopic radical nephroureterectomy is associated with worse survival outcomes than open radical nephroureterectomy in patients with locally advanced upper tract urothelial carcinoma. World J Urol 34(6):859–869. https://doi.org/10.1007/s00345-015-1712-3
Oya M, Kikuchi E (2015) Evidenced-based clinical practice guideline for upper tract urothelial carcinoma (summary–Japanese Urological Association, 2014 edition). Int J Urol 22(1):3–13. https://doi.org/10.1111/iju.12630
Matsuo S, Imai E, Horio M et al (2009) Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 53(6):982–992. https://doi.org/10.1053/j.ajkd.2008.12.034
Sobin LH, Gospodarowicz MK, Wittekind C, International Union against Cancer., ebrary Inc. (2009) TNM classification of malignant tumours. 7th edn. Wiley-Blackwell, Chichester, West Sussex, UK; Hoboken, NJ
Messer JC, Terrell JD, Herman MP et al (2013) Multi-institutional validation of the ability of preoperative hydronephrosis to predict advanced pathologic tumor stage in upper-tract urothelial carcinoma. Urol Oncol 31(6):904–908. https://doi.org/10.1016/j.urolonc.2011.07.011
Ito Y, Kikuchi E, Tanaka N et al (2011) Preoperative hydronephrosis grade independently predicts worse pathological outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma. J Urol 185(5):1621–1626. https://doi.org/10.1016/j.juro.2010.12.035
Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2
Galsky MD, Hahn NM, Rosenberg J et al (2011) A consensus definition of patients with metastatic urothelial carcinoma who are unfit for cisplatin-based chemotherapy. Lancet Oncol 12(3):211–214. https://doi.org/10.1016/S1470-2045(10)70275-8
Fang Z, Li L, Wang X et al (2014) Total retroperitoneal laparoscopic nephroureterectomy with bladder-cuff resection for upper urinary tract transitional cell carcinoma. J Invest Surg 27(6):354–359. https://doi.org/10.3109/08941939.2014.930214
Kubota Y, Nakaigawa N, Committee for Establishment of the Clinical Practice Guideline for the Management of Bladder C, the Japanese Urological A (2016) Essential content of evidence-based clinical practice guidelines for bladder cancer: the Japanese Urological Association 2015 update. Int J Urol 23(8):640–645. https://doi.org/10.1111/iju.13141
Kusaka A, Hatakeyama S, Hosogoe S et al (2017) Risk-stratified surveillance and cost effectiveness of follow-up after radical cystectomy in patients with muscle-invasive bladder cancer. Oncotarget. https://doi.org/10.18632/oncotarget.19043
Kusaka A, Hatakeyama S, Hosogoe S et al (2017) Detecting asymptomatic recurrence after radical cystectomy contributes to better prognosis in patients with muscle-invasive bladder cancer. Med Oncol 34(5):90. https://doi.org/10.1007/s12032-017-0955-9
Austin PC, Stuart EA (2015) Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 34(28):3661–3679. https://doi.org/10.1002/sim.6607
Walton TJ, Novara G, Matsumoto K et al (2011) Oncological outcomes after laparoscopic and open radical nephroureterectomy: results from an international cohort. BJU Int 108(3):406–412. https://doi.org/10.1111/j.1464-410X.2010.09826.x
Hosogoe S, Hatakeyama S, Kusaka A et al (2017) Platinum-based Neoadjuvant Chemotherapy Improves Oncological Outcomes in Patients with Locally Advanced Upper Tract Urothelial Carcinoma. Eur Urol Focus. https://doi.org/10.1016/j.euf.2017.03.013
Kubota Y, Hatakeyama S, Tanaka T et al (2017) Oncological outcomes of neoadjuvant chemotherapy in patients with locally advanced upper tract urothelial carcinoma: a multicenter study. Oncotarget. https://doi.org/10.18632/oncotarget.21551
Acknowledgements
The authors would like to thank Hiroyuki Ito, Kazuaki Yoshikawa, Atsushi Sasaki, Hiromichi Iwamura, Ken Fukushi, Jotaro Mikami, Takuma Narita, Toshikazu Tanaka, Itsuto Hamano, Yuki Fujita, Yukie Nishizawa, Satomi Sakamoto, and Yuriko Tanabe for their invaluable help with data collection. The authors would also like to thank Enago (www.enago.jp) for the English language review.
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Contributions
Conception and design: Shingo Hatakeyama. Acquisition of data: Koichi Kido, Naoki Fujita, Shingo Hatakeyama, Takahiro Yoneyama, Yasuhiro Hashimoto, Takuya Koie, Ikuya Iwabuchi, Masaru Ogasawara, Toshiaki Kawaguchi. Analysis and interpretation of data: Shingo Hatakeyama, Yuki Tobisawa, Tohru Yoneyama. Drafting of the manuscript: Koichi Kido, Shingo Hatakeyama. Critical revision of the manuscript: Naoki Fujita, Takuya Koie, Chikara Ohyama. Statistical analysis: Shingo Hatakeyama, Tohru Yoneyama. Obtaining funding: Shingo Hatakeyama, Takuya Koie, Chikara Ohyama. Administrative, technical, or material support: Yuki Tobisawa, Tohru Yoneyama
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The authors declare no conflicts of interest.
Financial disclosure
This work was supported by a Grant-in-Aid for Scientific Research (No. 15H02563, 15K15579, 17K11118, 17K11119, 17K16768, 17K16770, and 17K16771) from the Japan Society for the Promotion of Science.
Ethical standards
This study was performed in accordance with the ethical standards of the Declaration of Helsinki and approved by an ethics review board of Hirosaki University School of Medicine (authorization numbers; 2017–089) and all other hospitals.
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For this type of study, formal written consent is not required. Pursuant to the provisions of the ethics committee and the ethic guideline in Japan, written consent was not required in exchange for public disclosure of study information in the case of retrospective and/or observational study using a material such as the existing documentation. The study information was open for the public consumption at http://www.med.hirosaki-u.ac.jp/~uro/html/IRB/IRBdoc.html.
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Kido, K., Hatakeyama, S., Fujita, N. et al. Oncologic outcomes for open and laparoscopic radical nephroureterectomy in patients with upper tract urothelial carcinoma. Int J Clin Oncol 23, 726–733 (2018). https://doi.org/10.1007/s10147-018-1248-9
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DOI: https://doi.org/10.1007/s10147-018-1248-9