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).
World journal of urology. 2024 May 22*** epublish ***
Simone Morra, Reha-Baris Incesu, Lukas Scheipner, Andrea Baudo, Letizia Maria Ippolita Jannello, Carolin Siech, Mario de Angelis, Zhe Tian, Massimiliano Creta, Gianluigi Califano, Claudia Collà Ruvolo, Fred Saad, Shahrokh F Shariat, Felix K H Chun, Ottavio de Cobelli, Gennaro Musi, Alberto Briganti, Derya Tilki, Sascha Ahyai, Luca Carmignani, Nicola Longo, Pierre I Karakiewicz
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada. ., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada., Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany., Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy., Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Medical University of Graz, Graz, Austria., Department of Urology, IRCCS Policlinico San Donato, Milan, Italy.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/38775841