Abstract
Objective
To determine factors associated with performing inadvertent radical nephrectomy (RN)
for upper tract urothelial carcinoma (UTUC), and to assess the impact of radical nephrectomy
on overall survival (OS) compared to radical nephroureterectomy (NU).
Methods
Using the National Cancer Database (NCDB), patients with UTUC of the renal pelvis
who were diagnosed with renal cortical tumors and underwent RN (n = 820) with subsequent
surgical pathology demonstrating urothelial carcinoma were identified. These patients
were compared to those diagnosed with renal pelvis tumors who appropriately underwent
NU (n = 16,464) between 2005 and 2015. Multivariable logistic regression was used
to determine patient, facility and tumor-related factors associated with undergoing
RN. The impact of surgery (RN vs NU) on OS was determined by Cox-regression after
propensity score matching.
Results
A total of 4.7% patients with UTUC underwent inadvertent RN. Black race (adjusted
odds ratio [aOR] 1.62, 95%CI 1.23-2.13), larger tumors, advanced tumor stage, and
high-grade tumors (P < 0.0001) were associated with RN. However, surgery at a facility performing a higher
volume of NU/year was associated with lower odds of having RN performed (aOR 0.85,
95%CI 0.75-0.97). After propensity score matching, the 5-year OS was 39.9% for those
undergoing RN vs 49.9% for those undergoing NU (hazard ratio 1.45, 95%CI 1.30-1.62).
Conclusion
Inadvertent RN is not uncommon, occurring in almost 5% of patients with UTUC in the
NCDB. Patients who underwent RN had significantly worse OS as compared to those treated
with NU. These data highlight that accurate diagnosis of UTUC is paramount and clinicians
should not hesitate to perform further workup when imaging findings are equivocal.
Keywords
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Article info
Publication history
Published online: March 22, 2021
Accepted:
March 7,
2021
Received:
July 9,
2020
Footnotes
Conflict Of Interest: No conflict.
Funding Support: JS and DS are supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. JS is supported by Damon Runyon Cancer Research Foundation physician scientist training award. XM is partially reported by the following grant: Clinical and Translational Science Center at Weill Cornell Medicine (1-UL1-TR002384-01).
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