Long-term Outcomes of Nephron-Sparing Surgery Versus RNU for Organ-Localized UTUC

Patients who undergo radical nephroureterectomy (RNU) have comparative or better long-term outcomes than patients undergoing nephron-sparing surgery (NSS) for organ-localized upper urinary tract urothelial carcinoma (UTUC), according to a population-based study presented at the 2024 European Association of Urology Congress.

Researchers from the University First Hospital in Beijing, China, compared these management strategies by investigating patient prognostic factors and developing nomograms for overall survival (OS) and cancer-specific survival (CSS). A total of 1969 patients diagnosed with organ-localized (T1-2N0M0) UTUC from 2004 to 2020 were sampled from the Surveillance, Epidemiology, and End Results (SEER) database.

To identify prognostic factors and develop the nomograms, researchers utilized the propensity score overlap weighting (PSOW) process, Cox regression analysis, Kaplan-Meier (KM) analysis, competing-risks models, and subgroup analysis.

The OS and CSS nomograms were assessed using concordance index, calibration curve, and KM analysis.

Researchers observed no significant difference in 5-year OS (58.2% vs 62.4%, respectively) and 5-year CSS (77.0% vs 79.8%, respectively) between patients in the NSS and RNU groups.

Similarly, after PSOW, the main clinical characteristics were balanced between the groups, and no significant difference was observed in OS and CSS. However, univariate Cox analysis showed age, marital status, T stage, and grade had an impact on OS and CSS, and multivariate Cox analysis confirmed that age, T stage, and grade were independent prognostic factors of OS. Competing-risk analysis showed that advanced age, higher T stage, and higher grade were independent risk factors for CSS.

Upon further subgroup analysis, researchers found that RNU had positive effects on OS and CSS in women, patients aged older than 65 years, and patients with ureter lesions or advanced histologic grade (P<.05). Researchers also found that RNU was associated with higher OS than NSS among patients with T1 disease.

“Patients accepting RNU had a comparative or better outcome in each sample group,” study authors concluded, adding that NSS leads to “acceptable oncologic control” for select patients with organ-localized UTUC.