Risk Factors for Intravesical Recurrence after Minimally Invasive Nephroureterectomy for Upper Tract Urothelial Cancer (ROBUUST Collaboration)

Abstract

Purpose:Intravesical recurrence (IVR) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) has an incidence of approximately 20%–50%. Studies to date have been composed of mixed treatment cohorts—open, laparoscopic and robotic. The objective of this study is to assess clinicopathological risk factors for intravesical recurrence after RNU for UTUC in a completely minimally invasive cohort.Materials and Methods:We performed a multicenter, retrospective analysis of 485 patients with UTUC without prior or concurrent bladder cancer who underwent robotic or laparoscopic RNU. Patients were selected from an international cohort of 17 institutions across the United States, Europe and Asia. Univariate and multiple Cox regression models were used to identify risk factors for bladder recurrence.Results:A total of 485 (396 robotic, 89 laparoscopic) patients were included in analysis. Overall, 110 (22.7%) of patients developed IVR. The average time to recurrence was 15.2 months (SD 15.5 months). Hypertension was a significant risk factor on multiple regression (HR 1.99, CI 1.06; 3.71, p=0.030). Diagnostic ureteroscopic biopsy incurred a 50% higher chance of developing IVR (HR 1.49, CI 1.00; 2.20, p=0.048). Treatment specific risk factors included positive surgical margins (HR 3.36, CI 1.36; 8.33, p=0.009) and transurethral resection for bladder cuff management (HR 2.73, CI 1.10; 6.76, p=0.031).Conclusions:IVR after minimally invasive RNU for UTUC is a relatively common event. Risk factors include a ureteroscopic biopsy, transurethral resection of the bladder cuff, and positive surgical margins. When possible, avoidance of transurethral resection of the bladder cuff and alternative strategies for obtaining biopsy tissue sample should be considered.

Could Metabolic Syndrome Be a Predictor of Survival Outcomes in Upper Tract Urothelial Carcinoma? A Propensity Score Matching Study in a Large Chinese Center

“…Given the large differences in baseline BMI between Asian, and Western populations, collaborative international studies are needed to explained the controversy after rigorous matching. A meta-analysis including 10 studies showed that diabetes increased the risk of IVR in UTUC patients (21), and an international retrospective study discovered that hypertension was a significant risk factor for IVR based on data set from 17 centers worldwide (22). However, the effect of diabetes and hypertension on overall or cancer-specific survival has not been proven.…”

The Value of Lymph Node Dissection in Patients With Node-Positive Upper Urinary Tract Urothelial Cancer: A Retrospective Cohort Study

“…Second, the schedule or regime of adjuvant chemotherapy which has a potential impact on survival outcomes was not reported in the data repository. Third, the surgical method, such as open or laparoscopic, and the approach for bladder cuff management were not included in the SEER, and these factors may affect RLN yields or survival outcomes ( 24 ). Fourth, no data about smoking status or renal function before or after the operation were offered.…”

Conditional Intravesical Recurrence-Free Survival Rate After Radical Nephroureterectomy With Bladder Cuff Excision for Upper Tract Urothelial Carcinoma

“…Recently, Katims et al (31) reported the risk factors for IVR after minimally invasive RNUx. They reported that IVR occurred in 22.7% of patients who underwent RNUx.…”