Influence of tumour location on the survival outcomes of upper tract urothelial carcinoma treated with radical nephroureterectomy

TL;DR

This study found that tumor location in upper tract urothelial carcinoma affects progression-free survival but not overall survival or cancer-specific survival after surgery.

Contribution

The study provides new evidence on how tumor location influences survival outcomes in upper tract urothelial carcinoma patients.

Findings

Ureteral urothelial carcinoma was associated with worse progression-free survival compared to renal pelvic urothelial carcinoma.

No significant differences were found in overall survival, cancer-specific survival, or intravesical recurrence-free survival between the two tumor locations.

Abstract

To evaluate the impact of tumour location on the survival outcomes of patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).

Patients with ureteral urothelial carcinoma (UUC) or renal pelvic urothelial carcinoma (RPUC) of the Clinical Research Office of the Endourology Society (CROES)-UTUC registry were analyzed. Study outcomes included overall survival (OS), cancer-specific survival (CSS), intravesical recurrence-free survival (IRFS), and progression-free survival (PFS), which were compared using Kaplan–Meier method with log-rank test. Propensity score matching (PSM) was performed to balance the differences in tumour features between the two groups.

The UUC and RPUC groups consisted of 309 (41.9%) and 429 (58.1%) patients, respectively. RPUC group had larger tumour size (77.9% ≥ 2 cm vs 67.0% in UUC, p < 0.01), and more T3/T4 tumours (36.4% vs. 22. 0%, p < 0.01). The UUC group exhibited worse PFS compared to the RPUC group ( p = 0.029 for the initial analysis and p = 0.013 after PSM). However, there were no significant differences in OS (p = 0.088 before PSM and p = 0.255 after PSM), CSS (p = 0.106 before PSM and p = 0.101 after PSM), or IRFS (p = 0.112 before PSM and p = 0.28 after PSM) between the two groups.

Patients with ureteral urothelial carcinoma exhibited worse PFS compared to those with renal pelvic urothelial carcinoma. However, no significant differences were observed in OS, CSS, or IRFS between the two tumour locations. UTUC patients should be counselled about their individualized prognosis accordingly.

NCT02281188.

The online version contains supplementary material available at 10.1007/s00345-024-05432-0.

Figures