Objective: To test for survival differences after radical nephroureterectomy (RNU) in pT1-T3N0 upper tract urothelial carcinoma (UTUC) patients according to bladder cuff excision (BCE) status. Methods: Within the Surveillance, Epidemiology, and End Results database (2004–2020), we identified RNU patients and documented BCE status. Prior and after propensity score matching (ratio 1:1), cumulative incidence plots and competing risk regression (CRR) models addressed cancer specific mortality (CSM) and other-cause mortality (OCM). Results: Of 4,426 RNU-treated patients, 3,186 (72%) patients underwent BCE and 1,240 (28%) did not. BCE rates significantly increased over time from 65.2 to 77.0% (EAPC: +1.0%, 95% CI +0.4 to +1.6%, P = 0.004) between 2004 and 2020. After 1:1 propensity score matching for T stage, 1,240 of 1,240 (100%) RNU patients without BCE and 1,240 of 3,186 (39%) RNU patients with BCE were included in subsequent analyses. Five-year CSM rates were 30% in RNU with BCE vs. 36% in RNU without BCE patients (Δ = 6%). In multivariable CRR, RNU with BCE independently predicted lower CSM (HR: 0.81, 95% CI: 0.70–0.93; P < 0.001). Conversely, BCE status did not affect OCM (P = 0.4). Conclusion: The rate of guideline recommended BCE at RNU increased over time. Additionally, RNU with BCE is associated with significantly lower CSM than RNU without BCE in pT1-T3N0 UTUC patients. In consequence, BCE should represent an integral part of a comprehensive RNU.
Bladder cuff excision at radical nephroureterectomy improved survival in upper tract urothelial carcinoma / Di Bello, Francesco; Siech, Carolin; de Angelis, Mario; Rodriguez Peñaranda, Natali; Jannello, Letizia Maria Ippolita; Tian, Zhe; Goyal, Jordan A.; Colla Ruvolo, Claudia; Califano, Gianluigi; Mangiapia, Francesco; Saad, Fred; Shariat, Shahrokh F.; de Cobelli, Ottavio; Briganti, Alberto; Chun, Felix K. H.; Micali, Salvatore; Longo, Nicola; Karakiewicz, Pierre I.. - In: UROLOGIC ONCOLOGY. - ISSN 1078-1439. - 43:7(2025). [10.1016/j.urolonc.2025.02.014]
Bladder cuff excision at radical nephroureterectomy improved survival in upper tract urothelial carcinoma
Colla Ruvolo, Claudia;Califano, Gianluigi;Longo, Nicola;
2025
Abstract
Objective: To test for survival differences after radical nephroureterectomy (RNU) in pT1-T3N0 upper tract urothelial carcinoma (UTUC) patients according to bladder cuff excision (BCE) status. Methods: Within the Surveillance, Epidemiology, and End Results database (2004–2020), we identified RNU patients and documented BCE status. Prior and after propensity score matching (ratio 1:1), cumulative incidence plots and competing risk regression (CRR) models addressed cancer specific mortality (CSM) and other-cause mortality (OCM). Results: Of 4,426 RNU-treated patients, 3,186 (72%) patients underwent BCE and 1,240 (28%) did not. BCE rates significantly increased over time from 65.2 to 77.0% (EAPC: +1.0%, 95% CI +0.4 to +1.6%, P = 0.004) between 2004 and 2020. After 1:1 propensity score matching for T stage, 1,240 of 1,240 (100%) RNU patients without BCE and 1,240 of 3,186 (39%) RNU patients with BCE were included in subsequent analyses. Five-year CSM rates were 30% in RNU with BCE vs. 36% in RNU without BCE patients (Δ = 6%). In multivariable CRR, RNU with BCE independently predicted lower CSM (HR: 0.81, 95% CI: 0.70–0.93; P < 0.001). Conversely, BCE status did not affect OCM (P = 0.4). Conclusion: The rate of guideline recommended BCE at RNU increased over time. Additionally, RNU with BCE is associated with significantly lower CSM than RNU without BCE in pT1-T3N0 UTUC patients. In consequence, BCE should represent an integral part of a comprehensive RNU.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
