Upper urinary tract urothelial carcinoma (UTUC) is an uncommon disease and its gold-standard treatment is radical nephroureterectomy (RNU). Distal ureterectomy (DU) might be an alternative for tumors of the distal ureter but its indications remain unclear. Here, we aimed to evaluate the oncological outcomes of DU for UTUC of the pelvic ureter. We performed a multicenter retrospective analysis of patients with UTUC who underwent DU. The primary endpoint was 5-year cancer-specific survival (CSS), followed by overall survival (OS), intravesical recurrence-free (IVR) and homolateral urinary tract recurrence-free (HUR) survivals as secondary endpoints. Univariate and multivariate Cox regressions were performed to assess factors associated with outcomes. 155 patients were included, 91% of which were high-risk. 5-year CSS was 84.4%, OS was 71.9%, IVR-free survival was 43.6% and HUR-free survival was 74.4%. Multifocality, high grade and tumor size were the most significant predictors of survival endpoints. Of note, neither hydronephrosis nor pre-operative diagnostic ureteroscopy/JJ stent were associated with any of the endpoints. Perioperative morbidity was minimal. In conclusion, DU stands as a possible alternative to RNU for UTUC of the pelvic ureter. Close monitoring is mandatory due to the high risk of recurrence in the remaining urinary tract.
Cancers. 2022 Nov 06*** epublish ***
Alexandra Masson-Lecomte, Victoire Vaillant, Mathieu Roumiguié, Stéphan Lévy, Benjamin Pradère, Michaël Peyromaure, Igor Duquesne, Alexandre De La Taille, Cédric Lebâcle, Adrien Panis, Olivier Traxer, Priscilla Leon, Maud Hulin, Evanguelos Xylinas, François Audenet, Thomas Seisen, Yohann Loriot, Yves Allory, Morgan Rouprêt, Yann Neuzillet, French CCAFU Bladder Cancer Group
Department of Urology, APHP, Hôpital Saint Louis, 75010 Paris, France., Department of Urology, APHP, Hôpital Henri Mondor, Université Paris-Est Créteil, 94000 Créteil, France., Department of Urology, CHU de Toulouse, UPS, Université de Toulouse, 31000 Toulouse, France., Department of Urology-UROSUD, La Croix du Sud Hospital, 31130 Quint-Fonsegrives, France., Department of Urology, APHP, Hôpital Cochin, Université Paris Cité, 75014 Paris, France., Department of Urology, APHP, Hôpital Bicêtre, Université Paris Sud-Saclay, 94270 Le Kremlin-Bicêtre, France., GRC 10 Lithiase Urinaire, Department of Urology, APHP, Tenon Hospital, Sorbonne University, 75020 Paris, France., Department of Urology, clinique Pasteur, 17200 Royan, France., Department of Urology, APHP, Hôpital Bichat Claude-Bernard, Université Paris Cité, 75014 Paris, France., Department of Urology, APHP, Hôpital Européen Georges Pompidou, Université Paris Cité, 75014 Paris, France., GRC 5 Predictive Onco-Urology, Department of Urology, APHP, Pitié Salpêtrière Hospital, Sorbonne University, 75013 Paris, France., Department of Cancer Medicine, INSERM U981, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France., Department of Pathology, Curie Institute, University of Paris-Saclay-UVSQ, 92210 Saint-Cloud, France., Department of Urology, Hôpital Foch, University of Paris-Saclay-UVSQ, 92150 Suresnes, France.