Abstract
Purpose
To compare the long-term outcomes after nephron-sparing surgery (NSS) and radical nephroureterectomy (RNU) and investigate prognostic factors for organ-localized upper urinary tract urothelial carcinoma (UTUC) as the role of NSS for UTUC remains unclear.
Methods
Patients diagnosed with organ-localized UTUC between 2004 and 2020 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The propensity score overlap weighting (PSOW) process, Cox regression analysis, Kaplan‒Meier analysis, competing-risks models, and subgroup analysis were employed to compare the outcomes and identify prognostic factors. The overall survival (OS) and cancer-specific survival (CSS) nomograms were developed and evaluated using the concordance index (C-index) and calibration curve.
Results
A total of 1969 patients were included. After the process of PSOW, baseline data were well balanced. RNU was associated with similar OS and CSS than NSS in the overall cohort. Age, T stage, and histologic grade were independent prognostic factors for OS and CSS, while marital status was an independent prognostic factor only for OS. Four and three predictors were identified for developing the OS and CSS nomograms, respectively. C-index (OS 0.637, CSS 0.670), calibration curve, and Kaplan–Meier analysis proved excellent predictive accuracy of nomograms.
Conclusion
Patients accepting RNU had a comparative or better outcome in each sample group. NSS achieved a similar oncologic control for selected patients with organ-localized UTUC.
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Data availability
The datasets from the Surveillance, Epidemiology, and End Results registry for this study can be found at https://seer.cancer.gov/data/. All the data generated this study are included in this manuscript.
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Acknowledgements
The authors would like to give our sincere appreciation to the Surveillance, Epidemiology, and End Results database providing high-quality data for this study.
Funding
This work was supported by the National High Level Hospital Clinical Research Funding (Scientific Research Seed Fund of Peking University First Hospital, 2023SF40; and High Quality Clinical Research Project of Peking University First Hospital, 2022CR75), National Natural Science Foundation of China (No. 82141103; 82172617; 81872081), Capital’s Funds for Health Improvement and Research (2022-2-4074), and Sino-Russian Mathematics Center.
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JQ was responsible for project and protocol development, data collection, analysis, and manuscript writing. RD and CY did the graph and manuscript editing. KG contributed to the protocol and corrections to the article. All authors contributed to the article and approved the submitted version.
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Qiu, J., Deng, R., Yu, C. et al. The long-term outcome of nephron-sparing surgery versus radical nephroureterectomy for organ-localized upper urinary tract urothelial carcinoma: a population-based study of 1969 patients. J Cancer Res Clin Oncol 149, 14869–14878 (2023). https://doi.org/10.1007/s00432-023-05264-2
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DOI: https://doi.org/10.1007/s00432-023-05264-2