World Journal of Urology

, Volume 31, Issue 1, pp 69–76 | Cite as

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

  • Laurent Nison
  • Morgan Rouprêt
  • Grégory Bozzini
  • Adil Ouzzane
  • François Audenet
  • Géraldine Pignot
  • Alain Ruffion
  • Jean-Nicolas Cornu
  • Sophie Hurel
  • Antoine Valeri
  • Mathieu Roumiguie
  • Thomas Polguer
  • Nicolas Hoarau
  • Olivier Mérigot de Treigny
  • Evanguelos Xylinas
  • Alexandre Matte
  • Stéphane Droupy
  • Pierre Olivier Fais
  • Aurélien Descazeaud
  • Pierre Colin
  • MD for the French Collaborative National Database on UUT-UC
Topic Paper

Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Renal pelvis Ureter Urothelial carcinoma Nephroureterectomy Ureteroscopy Prognostic factors 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Laurent Nison
    • 1
  • Morgan Rouprêt
    • 2
  • Grégory Bozzini
    • 1
  • Adil Ouzzane
    • 1
  • François Audenet
    • 2
  • Géraldine Pignot
    • 3
  • Alain Ruffion
    • 4
  • Jean-Nicolas Cornu
    • 5
  • Sophie Hurel
    • 6
  • Antoine Valeri
    • 7
  • Mathieu Roumiguie
    • 8
  • Thomas Polguer
    • 9
  • Nicolas Hoarau
    • 10
  • Olivier Mérigot de Treigny
    • 8
  • Evanguelos Xylinas
    • 11
  • Alexandre Matte
    • 12
  • Stéphane Droupy
    • 13
  • Pierre Olivier Fais
    • 14
  • Aurélien Descazeaud
    • 15
  • Pierre Colin
    • 1
  • MD for the French Collaborative National Database on UUT-UC
  1. 1.Department of UrologyHôpital Claude Huriez, CHRU LilleLilleFrance
  2. 2.Department of UrologyUniversité Paris 6ParisFrance
  3. 3.Department of UrologyUniversité Paris 5, Hôpital CochinParisFrance
  4. 4.Department of UrologyCHU Lyon-SudLyonFrance
  5. 5.Department of UrologyHôpital TenonParisFrance
  6. 6.Department of UrologyHôpital Côte de NacreCaenFrance
  7. 7.Department of UrologyHôpital de la Cavale BlancheBrestFrance
  8. 8.Department of UrologyHôpital de RangueilToulouseFrance
  9. 9.Department of UrologyHôpital Gabriel-MontpiedClermont-FerrandFrance
  10. 10.Department of UrologyCHU AngersAngersFrance
  11. 11.Department of UrologyHôpital Henri MondorCreteilFrance
  12. 12.Department of UrologyHôpital Le BocageDijonFrance
  13. 13.Department of UrologyHôpital CarémeauNimesFrance
  14. 14.Department of UrologyHôpital NordMarseilleFrance
  15. 15.Department of UrologyHôpital DupuytrenLimogesFrance

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