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Long-Term Oncologic Outcomes of Laparoscopic Versus Open Radical Nephroureterectomy for Patients with T3N0M0 Upper Tract Urothelial Carcinoma: A Multicenter Cohort Study with Adjustment by Propensity Score Matching

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to investigate the long-term oncologic outcomes of laparoscopic radical nephroureterectomy (LRNU) and open radical nephroureterectomy (ORNU) for patients with clinical and pathologic T3N0M0 upper tract urothelial carcinoma (UTUC).

Methods

Among 375 UTUC patients who underwent radical nephroureterectomy, this study identified 144 pT3N0M0 patients as cohort 1 after propensity score (PS) matching. Among 399 UTUC patients, the study identified 110 cT3N0M0 patients as cohort 2 after PS matching. Oncologic outcomes such as intravesical recurrence-free survival (IVRFS) and cancer-specific survival (CSS) were assessed by multivariate Cox’s regression analysis.

Results

Cohort 1 of pT3N0M0 UTUC had 3-year CSS and IVRFS rates of 67.9 and 52.7%, respectively, in the LRNU group, which were significantly lower than in the ORNU group (81.4%, p = 0.039 and 71.6%, p = 0.046). The multivariate Cox’s regression analysis identified the type of surgical approach (LRNU vs. ORNU) as one of the independent prognostic factors for CSS (hazard rate [HR], 1.88, p = 0.043) and IVRFS (HR, 1.75, p = 0.049). Cohort 2 of cT3N0M0 UTUC had 3-year CSS and IVRFS rates of 48.5 and 41.4%, respectively, in the LRNU group, which were significantly lower than in the ORNU group (65.8%, p = 0.049 and 67.2%, p = 0.047), and the type of surgical approach (LRNU vs. ORNU) remained as one of the independent prognostic factors for CSS and IVRFS.

Conclusions

Based on clinical and pathologic T3N0M0 UTUC populations after PS adjustments, LRNU resulted in poorer CSS and IVRFS than ORNU.

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Acknowledgment

This work was supported in part by Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (#10649875). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Urology, Keio University School of Medicine, Tokyo, Japan

    Keisuke Shigeta MD, Eiji Kikuchi MD, PhD, Koichiro Ogihara MD, Tadanori Anno MD, Ryuichi Mizuno MD, PhD & Mototsugu Oya MD, PhD

  2. Department of Preventive Medicine and Public Health, Biostatistics Unit at the Clinical Translational Research Center, Keio University School of Medicine, Tokyo, Japan

    Takayuki Abe MD, PhD

  3. Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan

    Masayuki Hagiwara MD, PhD

  4. Department of Urology, Saitama City Hospital, Saitama, Japan

    Tadanori Anno MD

  5. Department of Urology, Saitama Medical Hospital, Saitama, Japan

    Tadanori Anno MD

  6. Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan

    Kota Umeda MD

  7. Department of Urology, International University of Health and Welfare Mita Hospital, Tokyo, Japan

    Yuto Baba MD

  8. Department of Urology, Isehara Kyodo Hospital, Kanagawa, Japan

    Tansei Sanjo MD

  9. Department of Urology, National Hospital Organization Saitama National Hospital, Saitama, Japan

    Kazunori Shojo MD

Authors
  1. Keisuke Shigeta MD
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  2. Eiji Kikuchi MD, PhD
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  3. Takayuki Abe MD, PhD
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  4. Masayuki Hagiwara MD, PhD
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  11. Ryuichi Mizuno MD, PhD
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  12. Mototsugu Oya MD, PhD
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Correspondence to Eiji Kikuchi MD, PhD.

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Shigeta, K., Kikuchi, E., Abe, T. et al. Long-Term Oncologic Outcomes of Laparoscopic Versus Open Radical Nephroureterectomy for Patients with T3N0M0 Upper Tract Urothelial Carcinoma: A Multicenter Cohort Study with Adjustment by Propensity Score Matching. Ann Surg Oncol 26, 3774–3781 (2019). https://doi.org/10.1245/s10434-019-07623-1

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  • DOI: https://doi.org/10.1245/s10434-019-07623-1

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