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Survival benefit of nephroureterectomy in systemic therapy exposed metastatic upper tract urinary urothelial carcinoma patients

  • 期刊论文

  • 发表日期：

    2024年5月22日

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  • Simone Morra,
  • Reha-Baris Incesu,
  • Lukas Scheipner,
  • Andrea Baudo,
  • Letizia Maria Ippolita Jannello,
  • Carolin Siech,
  • Mario de Angelis,
  • Zhe Tian,
  • Massimiliano Creta,
  • Gianluigi Califano,
  • Claudia Collà Ruvolo,
  • Fred Saad,
  • Shahrokh F. Shariat,
  • Felix K. H. Chun,
  • Ottavio de Cobelli,
  • Gennaro Musi,
  • Alberto Briganti,
  • Derya Tilki,
  • Sascha Ahyai,
  • Luca Carmignani,
  • Nicola Longo,
  • Pierre I. Karakiewicz

摘要

Background

It is unknown whether the stage of the primary may influence the survival (OS) of metastatic upper tract urothelial carcinoma (mUTUC) patients treated with nephroureterectomy (NU) and systemic therapy (ST). We tested this hypothesis within a large-scale North American cohort.

Methods

Within Surveillance Epidemiology and End Results database 2000–2020, all mUTUC patients treated with ST+NU or with ST alone were identified. Kaplan–Maier plots depicted OS. Multivariable Cox regression (MCR) models tested for differences between ST+NU and ST alone predicting overall mortality (OM). All analyses were performed in localized (T1–T2) and then repeated in locally advanced (T3–T4) patients.

Results

Of all 728 mUTUC patients, 187 (26%) harbored T1–T2 vs 541 (74%) harbored T3–T4. In T1–T2 patients, the median OS was 20 months in ST+NU vs 10 months in ST alone. Moreover, in MCR analyses that also relied on 3 months’ landmark analyses, the combination of ST+NU independently predicted lower OM (HR 0.37, p < 0.001). Conversely, in T3–T4 patients, the median OS was 12 in ST+NU vs 10 months in ST alone. Moreover, in MCR analyses that also relied on 3 months’ landmark analyses, the combination of ST+NU was not independently associated with lower OM (HR 0.85, p = 0.1).

Conclusions

In mUTUC patients, treated with ST, NU drastically improved survival in T1–T2 patients, even after strict methodological adjustments (multivariable and landmark analyses). However, this survival benefit did not apply to patients with locally more advanced disease (T3–T4).