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

Humans Nephroureterectomy Female Male Aged Ureteral Neoplasms / surgery Carcinoma, Transitional Cell / surgery Kidney Neoplasms / pathology Survival Rate Middle Aged Retrospective Studies Combined Modality Therapy Neoplasm Staging Aged, 80 and over
Cytoreductive nephroureterectomy Metastatic upper tract urothelial carcinoma Population-based analysis Systemic therapy-exposed patients

Journal

World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716

Informations de publication

Date de publication:
22 May 2024
Historique:
received: 05 02 2024
accepted: 13 05 2024
medline: 22 5 2024
pubmed: 22 5 2024
entrez: 22 5 2024
Statut: epublish

Résumé

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. 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. 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). 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).

Sections du résumé

BACKGROUND 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 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 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 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).

Identifiants

DOI: 10.1007/s00345-024-05057-3 PMID: 38775841
pubmed: 38775841
doi: 10.1007/s00345-024-05057-3
pii: 10.1007/s00345-024-05057-3
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

343

Informations de copyright

© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Références

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Auteurs

Simone Morra (S)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada. simonemorra@outlook.com.
Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy. simonemorra@outlook.com.
ORCID: 0000-0001-5340-8569

Reha-Baris Incesu (RB)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

Lukas Scheipner (L)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Department of Urology, Medical University of Graz, Graz, Austria.

Andrea Baudo (A)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Department of Urology, IRCCS Policlinico San Donato, Milan, Italy.

Letizia Maria Ippolita Jannello (LMI)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
Università Degli Studi Di Milano, Milan, Italy.

Carolin Siech (C)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany.

Mario de Angelis (M)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Zhe Tian (Z)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.

Massimiliano Creta (M)

Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy.

Gianluigi Califano (G)

Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy.

Claudia Collà Ruvolo (C)

Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy.

Fred Saad (F)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.

Shahrokh F Shariat (SF)

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Department of Urology, Weill Cornell Medical College, New York, NY, USA.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.

Felix K H Chun (FKH)

Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany.

Ottavio de Cobelli (O)

Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
Department of Oncology and Haemato-Oncology, Università Degli Studi Di Milano, 20122, Milan, Italy.

Gennaro Musi (G)

Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
Department of Oncology and Haemato-Oncology, Università Degli Studi Di Milano, 20122, Milan, Italy.

Alberto Briganti (A)

Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Derya Tilki (D)

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Department of Urology, Koc University Hospital, Istanbul, Turkey.

Sascha Ahyai (S)

Department of Urology, Medical University of Graz, Graz, Austria.

Luca Carmignani (L)

Department of Urology, IRCCS Policlinico San Donato, Milan, Italy.
Department of Urology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy.

Nicola Longo (N)

Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy.

Pierre I Karakiewicz (PI)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.

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questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie urogénitale › Procédures de chirurgie urologique › Néphrectomie › Néphro-urétérectomie › Survival benefit of nephroureterectomy in...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Survival benefit of nephroureterectomy in...
questionsmedicales.fr › Maladies urogénitales › Maladies urologiques › Tumeurs urologiques › Tumeurs de l'uretère › Survival benefit of nephroureterectomy in...
questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs épithéliales épidermoïdes et glandulaires › Carcinomes › Carcinome transitionnel › Survival benefit of nephroureterectomy in...
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questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Survival benefit of nephroureterectomy in...
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