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Nephron-sparing ureteroscopic surgery vs. radical nephroureterectomy: comparable survival-outcomes in upper tract urothelial carcinoma

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A Letter to the Editor to this article was published on 27 March 2024

Abstract

Purpose

This study investigates the utility of ureteroscopic surgery (URS) as an alternative to radical nephroureterectomy (RNU) in managing upper tract urothelial carcinoma (UTUC), with a focus on survival outcomes and re-evaluation of current the European Association of Urology guidelines criteria.

Methods

We conducted a retrospective, multi-institutional review of 143 UTUC patients treated with URS (n = 35) or RNU (n = 108). Clinicopathological factors were analyzed, and survival outcomes were assessed using Kaplan–Meier analysis and Cox proportional-hazards models.

Results

The median follow-up period was 27 months. Overall survival (OS) and radiographic progression-free survival (rPFS) were comparable between the URS and RNU groups (OS: HR 2.42, 95% CI 0.63–9.28, P = 0.0579; rPFS: HR 1.82, 95% CI 0.60–5.47, P = 0.1641). URS conferred superior renal function preservation. In patients characterized by factors such as radiographically invisible lesions, negative cytology, pTa stage, low-grade tumors, and multiple lesions, the OS outcomes with URS were comparable to those with RNU as follows: radiographically invisible lesions (P = 0.5768), negative cytology (P = 0.7626), pTa stage (P = 0.6694), low-grade tumors (P = 0.9870), and multiple lesions (P = 0.8586).

Conclusion

URS offers survival outcomes similar to RNU, along with better renal function preservation, especially in low-risk UTUC patients. These findings underscore the urgency of re-evaluating the current EAU guidelines and encourage further research into determining the ideal patient selection for URS in UTUC treatment.

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Data availability

No datasets were generated or analyzed during the current study.

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Acknowledgements

This work was partially supported by the Grant-in-Aid No. 22K20806 (Japan Society for the Promotion of Science: JSPS)

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Author notes

  1. Takuya Tsujino, Kazumasa Komura, Teruo Inamoto, Ryoichi Maenosono have contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Osaka Medical College, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan

    Takuya Tsujino, Kazumasa Komura, Teruo Inamoto, Ryoichi Maenosono, Satoshi Tokushige, Takaya Ohno, Shogo Yamazaki, Tatsuo Fukushima, Ko Nakamura, Yusuke Yano, Kazuki Nishimura, Shoko Kinoshita, Keita Nakamori, Takeshi Tsutsumi, Tomohisa Matsunaga, Yuki Yoshikawa, Taizo Uchimoto, Tomoaki Takai, Koichiro Minami, Hirofumi Uehara, Hajime Hirano, Hayahito Nomi & Haruhito Azuma

  2. Translational Research Program, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan

    Kazumasa Komura & Yoshio Ohno

  3. Department of Urology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Takeshi Hashimoto, Takahiro Adachi & Yosuke Hirasawa

  4. Department of Urology, Fujita-Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Kiyoshi Takahara

Authors
  1. Takuya Tsujino
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  2. Kazumasa Komura
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Contributions

TT: data collection and management, data analysis, Manuscript writing; KK: data management, Data analysis, project development; TI: data collection and management, project development; RM: data collection and management, data analysis; TH: data collection and management, project development; TA: data collection; YH: data collection; ST: data collection; TO: data collection; SY: data collection; TF: Data collection; KN: data collection; YY: data collection; KN: data collection. SK: data collection; KN: data collection; TT: data collection; TM: data collection; YY: data collection; TU: data collection; TT: data collection; KM: data collection; HU: data analysis; HH: data analysis; HN: data analysis; KT: Manuscript editing; YO: manuscript editing; HA: project development, manuscript editing.

Corresponding author

Correspondence to Takuya Tsujino.

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Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

This retrospective study involving human participants was approved by the institutional review board of Osaka Medical and Pharmaceutical University (IRB approval number: RIN-750-2571, date of approval: 24 January 2020) and conducted in accordance with the World Medical Association Declaration of Helsinki.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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Tsujino, T., Komura, K., Inamoto, T. et al. Nephron-sparing ureteroscopic surgery vs. radical nephroureterectomy: comparable survival-outcomes in upper tract urothelial carcinoma. World J Urol 41, 3585–3591 (2023). https://doi.org/10.1007/s00345-023-04687-3

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  • DOI: https://doi.org/10.1007/s00345-023-04687-3

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