Impact of Ureteroscopy Before Nephroureterectomy for Upper Tract Urothelial Carcinoma on Oncologic Outcomes

Abstract

Objective To compare the oncologic outcomes of patients with upper tract urothelial carcinoma (UTUC) undergoing nephroureterectomy (NU) with and without prior ureteroscopy (URS). Methods 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. Results 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%). Conclusions 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.

Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma Increased the Risk of Intravesical Recurrence

“…Lee et al [17] divided patients who underwent preoperative URS into 2 groups, depending on the timing of URS, and they found that delay of RNU after URS significantly increased the risk for IVR. Sankin et al [9] also found the same relationship between time delay and risk for IVR. In contrast, Sung et al [11] revealed that the concurrent and delayed RNU after URS did not make any difference in the incidence of IVR or time to bladder recurrence, making the issue more complicated.…”

“…All included studies in this review were retrospectively designed and inherently susceptible to selection bias, hence most studies included in this review reported that the baseline features were different between treatment arms and control arms [9, 10]. In addition, there are other possible differences that could be associated with the selection of diagnostic ureteroscopy and development of bladder cancer.…”

“…The general descriptions of included studies were summarised in Table 1. Among the included studies, 7 (60%) were from Asian countries [8, 10, 11, 13, 14, 17] and 3 studies were conducted in USA [9, 15, 16] and one in France [12], respectively. A total of 4,057 participants were included in the subsequent meta-analysis, of which 518 patients had a history of TCC in bladder.…”

Impact of ureteroscopy before radical nephroureterectomy for upper tract urothelial carcinomas on oncological outcomes: a meta‐analysis

“…In all, 20 studies were excluded because of insufficient outcomes, and one was excluded due to potentially overlapping study populations. Finally, eight studies were included in the present meta-analysis [20][21][22][23][24][25][26][27]. Table 1 summarises the characteristics of the included studies [20][21][22][23][24][25][26][27].…”

“…These patients with UTUC came from different countries or regions (USA, Japan, Austria, Canada, Germany, Italy, Chinese Taipei, France, Korea, and China) with a duration of follow-up of >12 months. Of the eight eligible studies, five studies [21][22][23][24]27] containing 2585 patients were conducted to investigate the impact of URS on the CSS of patients with UTUC after RNU, two studies [20,27] containing 297 patients investigated OS, two studies [22,24] containing 1780 patients investigated RFS, four studies [20,23,24,27] containing 1205 patients investigated MRS, and five studies [21,23,[25][26][27] containing 2099 patients investigated IRFS. Assessment of quality scores by the Newcastle-Ottawa scale showed that the scores of selected studies ranged from 7 to 9, which were considered adequate for the following meta-analysis ( Table 1).…”