ABSTRACT
OBJECTIVE
To assess clinical outcomes of patients who underwent simultaneous radical cystectomy
(RC) and radical nephroureterectomy (RNU) for panurothelial carcinoma (PanUC).
MATERIALS AND METHODS
A retrospective analysis of 67 patients who underwent simultaneous RC and unilateral
RNU for PanUC, from 1996 to 2017. Kaplan-Meier estimates for remnant urothelium recurrence-free
survival (RRFS), metastasis-free survival (MFS), overall survival (OS), and cancer-specific
survival (CSS) were performed. Cox multivariate models were constructed.
RESULTS
The median follow-up was 38 months, 29.8% of patients had a recurrence, 34.3% had
metastasis, 67.2% of patients died from any cause, and 37.3% died from urothelial
carcinoma. OS and CSS rates at 5 years were 44% and 61%, respectively. In multivariate
analysis, progression to muscle-invasive bladder cancer before surgery, presence of
muscle-invasive stages at RC and/or RNU, and prostatic urethra involvement were predictors
for worse MFS and CSS. Forty-one patients (61.2%) had an estimated glomerular filtration
rate (eGFR) <60 ml/min before surgery and the number rose to 56 (83.5%) after surgery;
29.8% patients needed renal function replacement therapy after surgery (16 haemodialysis
and 4 renal transplant).
CONCLUSION
Patients with PanUC who undergo simultaneous surgery have adverse oncological (only
4 out of every 10 remain alive at 5 years) and functional outcomes (1 out of 3 will
need renal function replacement therapy after surgery). Up to a third of the patients
had a recurrence (urethra or contralateral kidney) within 18 months, justifying close
surveillance or considering prophylactic urethrectomy. These data should help in counsel
on morbidity and life expectancy.
Keywords
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REFERENCES
- Clinical panurothelial disease in patients with superficial bladder tumors: therapeutic implications.J Urol. 2002; 167: 2007-2011
- Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy.Eur Urol. 2017; 71: 545-557
- Clinical Outcomes in Patients with Panurothelial Carcinoma Treated with Radical Nephroureterectomy Following Cystectomy for Metachronous Recurrence.J Urol. 2017; 198: 546-551
- Upper urinary tract recurrence following radical cystectomy for bladder cancer: a meta-analysis on 13,185 patients.J Urol. 2012; 188: 2046-2054
- European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (Ta, T1, and Carcinoma in Situ).Eur Urol. 2022; 81: 75-94
- European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update.Eur Urol. 2021; 79: 62-79
- European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2020 Guidelines.Eur Urol. 2021; 79: 82-104
- Endoscopic exploration directly impacts clinical decision making in the management of patients with suspected upper tract urothelial carcinoma following radical cystectomy.Urol Oncol. 2021; 39: 732 e1- e8
- Characteristics and treatment outcomes of pan-urothelial cell carcinoma: a descriptive analysis of 45 patients.Sci Rep. 2015; 5: 18014
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies.Int J Surg. 2014; 12: 1495-1499
- Urethral recurrence after radical cystectomy for urothelial carcinoma: A systematic review and meta-analysis.Urol Oncol. 2018; 36: 54-59
- A Contemporary Analysis of Urethral Recurrence following Radical Cystectomy.J Urol. 2021; 206: 970-977
- Diagnosis and treatment of urethral recurrence after radical cystectomy in the male.Actas Urol Esp. 2012; 36: 42-47
- Significance of prophylactic urethrectomy at the time of radical cystectomy for bladder cancer.Jpn J Clin Oncol. 2021; 51: 287-295
- Outcomes of patients undergoing concurrent radical cystectomy and nephroureterectomy: A single-institution series.Can Urol Assoc J. 2022; 16: E363-E3E9
- Predictive factors for impaired renal function following nephroureterectomy in upper urinary tract urothelial cell carcinoma.Urol Int. 2014; 92: 169-173
- Long-Term Renal Function Following Radical Cystectomy for Bladder Cancer.Urology. 2022; 160: 147-153
- Radical cystectomy for bladder cancer today–a homogeneous series without neoadjuvant therapy.J Clin Oncol. 2003; 21: 690-696
- Comparison of renal function after open radical cystectomy, extracorporeal robot assisted radical cystectomy, and intracorporeal robot assisted radical cystectomy.Urol Oncol. 2021; 39: 301 e1- e9
- Long-term renal function outcomes after radical cystectomy.J Urol. 2014; 191: 619-625
- Nephroureterectomy increase 5 year survival in patients on dialysis with upper urinary tract urothelial carcinoma.Oncotarget. 2017; 8: 79876-79883
- Ten-year survival outcomes after radical nephroureterectomy with a risk-stratified approach using prior diagnostic ureteroscopy: a single-institution observational retrospective cohort study.BJU Int. 2022; 129: 744-751
- Prediction of renal function after nephroureterectomy in patients with upper tract urothelial carcinoma.Jpn J Clin Oncol. 2015; 45: 1064-1068
- Complete urinary tract extirpation: the University of Maryland experience.Urology. 2006; 68: 65-69
- Different treatment strategies for end stage renal disease in patients with transitional cell carcinoma.J Urol. 2004; 171: 126-129
- Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant.N Engl J Med. 1999; 341: 1725-1730
- Template-based lymphadenectomy in urothelial carcinoma of the renal pelvis: a prospective study.Int J Urol. 2014; 21: 453-459
- The role of lymph node dissection in the management of urothelial carcinoma of the upper urinary tract.Int J Clin Oncol. 2011; 16: 170-178
Article Info
Publication History
Accepted:
August 29,
2022
Received:
July 13,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflict of interest: None
Identification
Copyright
© 2022 Published by Elsevier Inc.
