The oncologic impact of a delay between diagnosis and radical nephroureterectomy due to diagnostic ureteroscopy in upper urinary tract urothelial carcinomas: results from a large collaborative database
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According to the current upper urinary tract urothelial carcinomas (UTUC) guidelines, ureteroscopic evaluation (URS) is recommended to improve diagnostic accuracy and obtain a grade (by biopsy or cytology). However, URS may delay radical surgery [e.g., nephroureterectomy (RNU)]. The objective of this study was to evaluate the influence of URS implementation before RNU on patient survival.
A French multicentre retrospective study including 512 patients with nonmetastatic UTUC was conducted between 1995 and 2011. Achievement of ureteroscopy (URS), treatment time (time between imaging diagnosis and RNU), tumour location, pT–pN stage, grade, lymphovascular invasion (LVI) and the presence of invaded surgical margins (R+) were evaluated as prognostic factors for survival using univariate and multivariate Cox regression analyses. Cancer-specific survival (CSS), recurrence-free survival (RFS) and metastasis-free survival (MFS) were calculated using the Kaplan–Meier method.
A total of 170 patients underwent ureteroscopy prior to RNU (URS+ group), and 342 did not undergo URS (URS−). The median treatment time was significantly longer in the URS+ group (79.5 vs. 44.5 days, p = 0.04). Ureteroscopic evaluation was correlated with ureteral location and lower stage and tumour grade (p = 0.022, 0.005, 0.03, respectively). Tumour stage, LVI+ and R+ status were independently associated with CSS (p = 0.024, 0.049 and 0.006, respectively). The 5-year CSS, RFS and MFS did not differ between the two groups (p = 0.23, 0.89 and 0.35, respectively). These results were confirmed for muscle-invasive (MI) UTUC (p = 0.21, 0.44 and 0.67 for CSS, RFS and MFS, respectively).
Despite the increased time to radical surgery, diagnostic ureteroscopy can be systematically performed for the appraisal of UTUC to refine the therapeutic strategy without significantly affecting oncological outcomes, even for MI lesions.
KeywordsRenal pelvis Ureter Urothelial carcinoma Nephroureterectomy Ureteroscopy Prognostic factors
The authors would like to kindly thank other collaborators from the French Collaborative National Database on UTUC: Emilie Adam, Baptiste Albouy, Medhi-Mokhtar Ariane, Frédéric Arroua, Alexis Arvin Berod, Marie Audouin, Marie Dominique Azemar, Loic Baissa, Henri Bensadoun, Pierre Bigot, Thomas Bodin, Nicolas Brichart, Franck Bruyère, Luc Cormier, Sébastien Crouzet, Olivier Cussenot, Alexandre De la Taille, Francky Delage, Solène Gardic, Pascal Gres, Julien Guillotreau, Laurent Guy, Alain Houlgatte, Jacques Irani, Gilles Karsenty, Jean-Alexandre Long, Charles Marchand, Charlotte Maurin, Yann Neuzillet, François Xavier Nouhaud, Véronique Phé, Emmanuel Ravier, François Rozet, Fabien Saint, Frédéric Staerman, Michel Soulié, David R Yates and Marc Zerbib.
Conflict of interest
None of the contributing authors have any conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.
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