Presentation Authors: Jiwoong Yu, Shihyun Sung*, Chung Un Lee, Minyong Kang, Hwang Gyun Jeon, Byung Chang Jeong, Seong Il Seo, Seong Soo Jeon, Hyun Moo Lee, Hyun Hwan Sung, Seoul, Korea, Republic of
Introduction: Radical nephroureterectomy (RNU) is standard treatment in upper tract urothelial carcinoma (UTUC). Recently, nephron sparing surgery in upper tract urothelial carcinoma (UTUC) has emerged as a major interest. In this study, we compared oncologic and functional outcomes between RNU and SU in UTUC.
Methods: Our analyses involved 394 patients treated with RNU from 2008 to 2016 and 38 patients treated with SU from 2009 to February 2018. Patient variables were adjusted with sex, age, year of operation, T stage and grade by 1:1 propensity score matching. Progression free survival (PFS), cancer specific survival (CSS), overall survival (OS), upper tract cancer recurrence free survival (UTC-RFS), bladder cancer recurrence free survival (BC-RFS) and eGFR preservation rate after operation were analyzed.
Results: After propensity score matching, 37 patients were included in each group, and well balanced. Patients characteristecs were shown in Table 1. The PFS, CSS, OS BC-RFS rates showed no significant differences between RNU and SU (p = 0.568, p = 0.711, p = 0.119, p = 0.792 respectively). There was no significant survival difference acoording to high grade or T3 stage. However, regarding UTC-RFS, SU group is more likely to recur. (UTC-RFS 97.2 % vs 91.5 % at 3-year, p < 0.001) (Figure 1) In the multivariate regression model, the type of surgery failed to affect for progression, caner specific mortality and all-cause mortality. In terms of renal function, eGFR preservation rate after 1 year of operation, SU was superior to RNU. (78.3 Â± 24.6 % vs 109.2 Â± 29.8 %, p < 0.001)
Conclusions: No significant PFS, CSS, OS and BC-RFS differences were demonstated between surgical approaches for UTUC and no significant survival differences were shown according to high grade or T3 stage. But upper tract recurrence is more common in SU. Patients who underwent SU show superior results in preservation of renal function compared with RNU.