To compare the oncologic outcomes of patients with upper tract urothelial carcinoma (UTUC) undergoing nephroureterectomy (NU) with and without prior ureteroscopy (URS).
We reviewed records of all patients with no prior history of bladder cancer that underwent NU at our institution (n = 201).
We compared patients who underwent URS prior to NU to patients who proceeded directly to NU based on imaging alone. After excluding patients undergoing URS with therapeutic intent, we used multivariable Cox proportional hazards models, adjusting for tumor characteristics with cancer specific survival (CSS), intravesical recurrence free survival (IRFS), metastasis free survival (MFS), and overall survival (OS) as endpoints.
144 (72%) patients underwent URS prior to NU and 57 (28%) patients proceeded directly to NU. The median follow up time for survivors was 5.4 years from diagnosis. The performance of diagnostic URS prior to NU was significantly associated with IR (HR 2.58; 95% CI 1.47, 4.54; p = 0.001), although it was not associated with CSS, MFS, or OS. The adjusted IRFS probability 3 years after diagnosis is 71% and 42% for patients who did not and did receive URS prior to NU, respectively (adjusted risk difference 30%; 95% CI 13%, 47%).
We did not find evidence that URS adversely impacts disease progression and survival in patients with UTUC. Although patients are at higher risk for IR after NU when they have undergone prior diagnostic URS, their CSS, MFS, and OS are not significantly affected.
Urology. 2016 May 26 [Epub ahead of print]
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Alexander Sankin, Amy L Tin, Roy Mano, Michael Chevinsky, Chris Jakubowski, John P Sfakianos, Eugene K Cha, Alyssa Yee, Fara M Friedman, Daniel D Sjoberg, Behfar Ehdaie, Jonathan Coleman
Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: ., Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA., Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA., Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA., Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA., Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA., Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA., Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA., Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA., Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.