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, metastasis-free survival, 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. Overall survival 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 metastasis-free survival 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.
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Article info
Publication history
Published online: November 24, 2022
Accepted:
August 29,
2022
Received:
July 13,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
