The oncologic impact of a delay between diagnosis and radical nephroureterectomy due to diagnostic ureteroscopy in upper urinary tract urothelial carcinomas: results from a large collaborative database.
OBJECTIVE
According to the current upper urinary tract urothelial carcinomas (UTUC) guidelines, ureteroscopic evaluation (URS) is recommended to improve diagnostic accuracy and obtain a grade (by biopsy or cytology). However, URS may delay radical surgery [e.g., nephroureterectomy (RNU)]. The objective of this study was to evaluate the influence of URS implementation before RNU on patient survival.


METHODS
A French multicentre retrospective study including 512 patients with nonmetastatic UTUC was conducted between 1995 and 2011. Achievement of ureteroscopy (URS), treatment time (time between imaging diagnosis and RNU), tumour location, pT-pN stage, grade, lymphovascular invasion (LVI) and the presence of invaded surgical margins (R+) were evaluated as prognostic factors for survival using univariate and multivariate Cox regression analyses. Cancer-specific survival (CSS), recurrence-free survival (RFS) and metastasis-free survival (MFS) were calculated using the Kaplan-Meier method.


RESULTS
A total of 170 patients underwent ureteroscopy prior to RNU (URS+ group), and 342 did not undergo URS (URS-). The median treatment time was significantly longer in the URS+ group (79.5 vs. 44.5 days, p = 0.04). Ureteroscopic evaluation was correlated with ureteral location and lower stage and tumour grade (p = 0.022, 0.005, 0.03, respectively). Tumour stage, LVI+ and R+ status were independently associated with CSS (p = 0.024, 0.049 and 0.006, respectively). The 5-year CSS, RFS and MFS did not differ between the two groups (p = 0.23, 0.89 and 0.35, respectively). These results were confirmed for muscle-invasive (MI) UTUC (p = 0.21, 0.44 and 0.67 for CSS, RFS and MFS, respectively).


CONCLUSIONS
Despite the increased time to radical surgery, diagnostic ureteroscopy can be systematically performed for the appraisal of UTUC to refine the therapeutic strategy without significantly affecting oncological outcomes, even for MI lesions.
Department of Urology, Hôpital Claude Huriez, CHRU Lille, Rue Michel Polonovski, 59037, Lille, France. laurent_nison@msn.com
Laurent
L
Nison
Morgan
M
Rouprêt
Grégory
G
Bozzini
Adil
A
Ouzzane
François
F
Audenet
Géraldine
G
Pignot
Alain
A
Ruffion
Jean-Nicolas
JN
Cornu
Sophie
S
Hurel
Antoine
A
Valeri
Mathieu
M
Roumiguie
Thomas
T
Polguer
Nicolas
N
Hoarau
Olivier
O
Mérigot de Treigny
Evanguelos
E
Xylinas
Alexandre
A
Matte
Stéphane
S
Droupy
Pierre Olivier
PO
Fais
Aurélien
A
Descazeaud
Pierre
P
Colin
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy; D012189:Retrospective Studies; D013997:Time Factors; D014516:Ureteral Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018666:Ureteroscopy