Minimally Invasive RNU Linked to Improved OS in Octogenarian Patients With UTUC

In patients with urothelial carcinoma, upper tract urothelial carcinoma (UTUC) is rare, comprising just 5% to 10% of all diagnoses. For those with localized high-risk disease, radical nephroureterectomy (RNU) is the standard of care.

Minimally invasive (MIS) RNU has been linked to shorter hospital stays, reduced need for blood transfusions, and improved recovery, which are important considerations for older patients.

Shaun Trecarten, BMBS, and colleagues examined trends in surgical approach selection and patient outcomes in open versus MIS RNU in patients aged 80 years and older.

They collected patient data using the National Cancer Database and identified patients aged ≥80 years who underwent open or MIS (either robotic or laparoscopic) RNU from 2010 to 2019. Multivariate logistic regression models were used to assess demographic, patient-related, and disease-specific factors associated with open or MIS RNU.

Inverse probability of treatment weighting (IPTW) was used to adjust for confounding variables, and a survival analysis was also conducted on the IPTW-adjusted cohort using Kaplan-Meier plots and Cox proportional hazards regression.

A total of 5687 patients were identified; 1431 (25.2%) underwent open RNU, while 4256 (74.8%) underwent MIS RNU. The use of robotic RNU increased from 12.5% in 2010 to 50.4% in 2019. Compared with open surgery, MIS RNU was associated with shorter hospital length of stay (4.7 vs 5.9 days, SMD 23.7%), as well as a significant reduction in 90-day mortality (odds ratio, 0.571; 95% CI, 0.34-0.96; P=.033) and improved median overall survival (OS; 53.8 months [95% CI, 50.9-56.9] vs 42.35 months [95% CI, 38.6-46.8]; P<.001).

An IPTW-adjusted survival analysis showed improved OS with MIS RNU compared with open surgery, with a survival benefit of 46.1 months (95% CI, 40.2-52.4) versus 37.7 months (95% CI, 32.6-46.5; P=.0034), respectively. The analysis also showed that MIS RNU was linked to reduced mortality (hazard ratio, 0.76; 95% CI, 0.66-0.87; P<.001).

Overall, the use of MIS RNU is associated with improved median OS and 90-day mortality in octogenarian patients with UTUC.