Oncological Outcomes of Adjuvant Radiotherapy for Partial Ureterectomy in Distal Ureteral Urothelial Carcinoma Patients
Hong-Zhen Li, Xiaoying Li, Xian-Shu Gao, Xin Qi, Ming-Wei Ma, Shangbin Qin, Hong-Zhen Li, Xiaoying Li, Xian-Shu Gao, Xin Qi, Ming-Wei Ma, Shangbin Qin
Abstract
Purpose: We retrospectively analyzed the oncological outcomes of T3 or G3 distal ureteral urothelial carcinoma (DUUC) underwent partial ureterectomy (PU) followed by adjuvant radiotherapy (ART).
Methods: From January 2008 to September 2019, clinical data from a total of 221 patients with pathologic T3 or G3 who underwent PU or RNU at our hospital were analyzed. 17 patients of them were treated with PU+ART, 72 with PU alone and 132 with radical nephroureterectomy (RNU). Clinicopathologic outcomes were evaluated. Survival was assessed using the Kaplan-Meier method. Cox regression addressed recurrence-free survival (RFS), metastasis-free survival (MFS), cancer specific survival (CSS) and overall survival (OS).
Results: Median age and follow-up time were 68 (IQR 62-76) years old and 43 (IQR 28-67) months, respectively. In univariate and multivariable analyses, no lymph node metastasis(LNM) and ART were independent prognostic factors of RFS (p=0.031 and 0.016, respectively). ART significantly improved 5-year RFS compared with the PU alone, (67.6% vs. 39.5%, HR: 2.431, 95%CI 1.210-4.883, p=0.039). There was no statistical difference in 5-year RFS between PU+ART and RNU groups (67.6% vs. 64.4%, HR=1.113, 95%CI 0.457-2.712, p=0.821). Compared with PU alone or RNU, PU+ART demonstrated no statistical difference in 5-year MFS (PU+ART 73.2%, PU 57.2%, RNU69.4%), CSS (70.7%, 55.1%, 76.6%, respectively), and OS (70.7%, 54.1%, 69.2%, respectively).
Conclusions: For distal ureteral urothelial carcinoma patients with T3 or G3, adjuvant radiotherapy could significantly improve recurrence-free survival compared with partial ureterectomy alone. There was no significant difference between survival outcomes of PU+ART and radical nephroureterectomy.
Keywords: adjuvant radiotherapy; partial ureterectomy; radical nephroureterectomy; recurrence-free survival (RFS); urothelial carcinoma.
Conflict of interest statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Copyright © 2021 Li, Li, Gao, Qi, Ma and Qin.
Figures
References
- Rouprêt M, Babjuk M, Burger M, Capoun O, Cohen D, Compérat EM, et al. . European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update. Eur Urol (2020) 79(1):62–79. doi: 10.1016/j.eururo.2020.05.042
- Seisen T, Peyronnet B, Dominguez-Escrig JL, Bruins HM, Yuan CY, Babjuk M, et al. . Oncologic Outcomes of Kidney-Sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-Muscle Invasive Bladder Cancer Guidelines Panel. Eur Urol (2016) 70(6):1052–68. doi: 10.1016/j.eururo.2016.07.014
- Cutress ML, Stewart GD, Tudor EC, Egong EA, Wells-Cole S, Phipps S, et al. . Endoscopic Versus Laparoscopic Management of Noninvasive Upper Tract Urothelial Carcinoma: 20-Year Single Center Experience. J Urol (2013) 189(6):2054–60. doi: 10.1016/j.juro.2012.12.006
- Raymundo EM, Lipkin ME, Banez LB, Mancini JG, Zilberman DE, Preminger GM, et al. . Third Prize: The Role of Endoscopic Nephron-Sparing Surgery in the Management of Upper Tract Urothelial Carcinoma. J Endourol (2011) 25(3):377–84. doi: 10.1089/end.2010.0276
- Jwa E, Kim YS, Ahn H, Kim CS, Lee JL, Kim SO, et al. . Adjuvant Radiotherapy for Stage III/IV Urothelial Carcinoma of the Upper Tract. Anticancer Res (2014) 34(1):333–8. doi: 10.1016/j.lungcan.2013.10.009
- Chen B, Zeng ZC, Wang GM, Zhang L, Lin ZM, Sun LA, et al. . Radiotherapy may Improve Overall Survival of Patients With T3/T4 Transitional Cell Carcinoma of the Renal Pelvis or Ureter and Delay Bladder Tumour Relapse. BMC Cancer (2011) 11:297. doi: 10.1186/1471-2407-11-297
- Jang NY, Kim IA, Byun SS, Lee SE, Kim JS. Patterns of Failure and Prognostic Factors for Locoregional Recurrence After Radical Surgery in Upper Urinary Tract Transitional Cell Carcinoma: Implications for Adjuvant Radiotherapy. Urol Int (2013) 90(2):202–6. doi: 10.1159/000343729
- Li X, Cui M, Gu X, Fang D, Li H, Qin S, et al. . Pattern and Risk Factors of Local Recurrence After Nephroureterectomy for Upper Tract Urothelial Carcinoma. World J Surg Oncol (2020) 18(1):114. doi: 10.1186/s12957-020-01877-w
- Speakman MJ, Khastgir L. Campbell-Walsh Urology 9th Edition, e-edition. BJU Inter (2007) 100(2):453–4. doi: 10.1111/j.1464-410x.2007.07073.x
- Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2020. CA Cancer J Clin (2020) 70(1):7–30. doi: 10.3322/caac.21590
- Bagrodia A, Kuehhas FE, Gayed BA, Wood CG, Raman JD, Kapur P, et al. . Comparative Analysis of Oncologic Outcomes of Partial Ureterectomy vs Radical Nephroureterectomy in Upper Tract Urothelial Carcinoma. Urology (2013) 81(5):972–7. doi: 10.1016/j.urology.2012.12.059
- Colin P, Ouzzane A, Pignot G, Ravier E, Crouzet S, Ariane MM, et al. . Comparison of Oncological Outcomes After Segmental Ureterectomy or Radical Nephroureterectomy in Urothelial Carcinomas of the Upper Urinary Tract: Results From a Large French Multicentre Study. BJU Int (2012) 110(8):1134–41. doi: 10.1111/j.1464-410X.2012.10960.x
Source: PubMed