title: Equivalent survival and improved preservation of renal function after distal ureterectomy compared with nephroureterectomy in patients with urothelial carcinoma of the distal ureter: a propensity score-matched multicenter study.
abstract: OBJECTIVE
  To investigate the oncological and functional outcome of distal ureterectomy compared with nephroureterectomy in the management of distal ureteral urothelial carcinoma.
  
  
  METHODS
  Using a database including upper urinary tract urothelial carcinoma patients (n = 1329), 282 patients were identified with urothelial carcinoma localized in the distal ureter on clinical evaluation. To adjust for potential baseline differences between groups, 43 patients undergoing distal ureterectomy were matched with 86 patients undergoing nephroureterectomy using propensity scoring. Cox regression models tested the effect of surgery type on recurrence-free survival and cancer-specific survival. Estimated glomerular filtration rate was measured before and after surgery.
  
  
  RESULTS
  The median follow-up period was 50 months. There were no significant differences in 5-year recurrence-free survival and cancer-specific survival rates between the distal ureterectomy and nephroureterectomy groups (P = 0.22 and P = 0.70, respectively). Multivariate analysis showed that surgery type was not associated with recurrence-free survival and cancer-specific survival (P = 0.90 and P = 0.28, respectively). In the subanalysis, recurrence-free survival and cancer-specific survival in the distal ureterectomy group were equivalent to those of the nephroureterectomy group in both pTa-1 and pT2-4 patients. Renal function was better preserved in the distal ureterectomy group than in the nephroureterectomy group (rate of change in estimated glomerular filtration rate 2% vs -20%; P < 0.001).
  
  
  CONCLUSIONS
  The oncological outcome of distal ureterectomy is comparable with that of nephroureterectomy in distal ureteral urothelial carcinoma patients, and distal ureterectomy provides better preservation of renal function. Distal ureterectomy would be feasible for carefully selected patients with distal ureteral urothelial carcinoma.
authors.affiliation: Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukushima
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Saito
authors.forename: Junichiro
authors.initials: J
authors.lastname: Ishioka
authors.forename: Yoh
authors.initials: Y
authors.lastname: Matsuoka
authors.forename: Noboru
authors.initials: N
authors.lastname: Numao
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Koga
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masuda
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Sakai
authors.forename: Chizuru
authors.initials: C
authors.lastname: Arisawa
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Okuno
authors.forename: Junji
authors.initials: J
authors.lastname: Yonese
authors.forename: Shigeyoshi
authors.initials: S
authors.lastname: Kamata
authors.forename: Katsushi
authors.initials: K
authors.lastname: Nagahama
authors.forename: Akira
authors.initials: A
authors.lastname: Noro
authors.forename: Shinji
authors.initials: S
authors.lastname: Morimoto
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Tsujii
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kitahara
authors.forename: Shuichi
authors.initials: S
authors.lastname: Gotoh
authors.forename: Yotsuo
authors.initials: Y
authors.lastname: Higashi
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kihara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009392:Nephrectomy / Q000706:statistics & numerical data*; D057216:Propensity Score; D012189:Retrospective Studies; D014516:Ureteral Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*
keywords: cancer-specific survival; distal ureteral urothelial carcinoma; distal ureterectomy; nephroureterectomy; renal function