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Tytuł:
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Comparing oncological outcomes of laparoscopic vs open radical nephroureterectomy for the treatment of upper tract urothelial carcinoma: A propensity score-matched analysis.
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Autorzy:
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Moschini M; Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.; Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland.
Zamboni S; Urology Unit, ASST Spedali Civili, Brescia, Italy.; Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy.
Afferi L; Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland.
Pradere B; Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.; Department of Urology, CHRU Tours, Francois Rabelais University, Tours, France.
Abufaraj M; Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.; Division of Urology, Department of Special Surgery, Jordan University Hospital, the University of Jordan, Amman, Jordan.
Soria F; Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.; Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy.
D'Andrea D; Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
Roupret M; Urology, Assistance Publique-Hôpitaux De Paris (AP-HP), Sorbonne University, Hopital Pitié Salpétrière, Paris, France.
De la Taille A; Department of Urology, Assistance Publique-Hôpitaux De Paris (AP-HP) CHU Mondor, Faculté De Médecine, Henri Mondor Hospital, Créteil, France.
Simeone C; Urology Unit, ASST Spedali Civili, Brescia, Italy.
Mattei A; Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland.
Mathieu R; Urology, Rennes University Hospital (France), Rennes, France.
Bensalah K; Urology, Rennes University Hospital (France), Rennes, France.
Wirth MP; Department of Urology, University Hospital Carl Gustav Carus, Dresden, Germany.
Montorsi F; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
Briganti A; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
Gallina A; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
Simone G; Department of Urology, 'Regina Elena' National Cancer Institute, Rome, Italy.
Gallucci M; Department of Urology, 'Regina Elena' National Cancer Institute, Rome, Italy.
Di Bona C; Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland.
Marra G; Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy.
Mari A; Department of Urology, University of Florence, Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy.
Di Trapani E; Department of Urology, European Institute of Oncology (IEO), Milan, Italy.
Alvarez Maestro M; Department of Urology, La Paz University Hospital, Madrid, Spain.
Krajewski W; Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland.
Shariat SF; Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.; Department of Urology, Weill Cornell Medical College, New York, NY, USA.; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.; Department of Urology, Motol Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
Xylinas E; Department of Urology, CHU Bichat, Paris, France.
Baumeister P; Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland.
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Źródło:
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Arab journal of urology [Arab J Urol] 2020 Sep 04; Vol. 19 (1), pp. 31-36. Date of Electronic Publication: 2020 Sep 04.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: 2019- : [Philadelphia, PA] : Taylor & Francis
Original Publication: Cairo : Arab Association of Urology
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References:
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Contributed Indexing:
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Keywords: RNU; UTUC; Upper tract urothelial carcinoma; laparoscopic; open; radical nephroureterectomy
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Entry Date(s):
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Date Created: 20210325 Latest Revision: 20220421
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Update Code:
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20240105
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PubMed Central ID:
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PMC7954493
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DOI:
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10.1080/2090598X.2020.1817720
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PMID:
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33763246
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Objectives: To compare oncological outcomes of open (ORNU) and laparoscopic radical nephroureterectomy (LRNU) after controlling for preoperative patient-derived factors.
Patients and Methods: We evaluated a multi-institutional collaborative database composed of 3984 patients diagnosed with upper tract urothelial carcinoma (UTUC) treated with RNU between 2006 and 2018. To adjust for potential selection bias, propensity score matching adjusted for age, gender and American society Anesthesiology (ASA) score was performed with one ORNU patient matched to one LRNU patient. Uni- and multivariable Cox regression evaluating the risk of overall recurrence, cancer-specific mortality (CSM) and overall mortality (OM) in the overall population and after propensity matching were performed.
Results: In total, 3984 patients underwent RNU, of these 3227 (81%) patients were treated with ORNU and 757 (19%) patients with LRNU. Within a median follow-up of 62 months, 1276 recurrences, 844 CSMs and 1128 OMs were recorded. On multivariable analyses, the LRNU approach was associated with an increased risk of overall recurrence (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.03-1.54; P = 0.02), but on the other hand LRNU was associated with a protective effect on CSM (HR 0.74, 95% CI 0.56-0.98; P = 0.04). After propensity matching analyses adjusted for age, gender and ASA score, 757 patients treated with LRNU and 757 patients treated with ORNU were available for the analyses. On multivariable Cox regression, LRNU vs ORNU was not associated with any difference in overall recurrence ( P = 0.08), CSM ( P = 0.1) or OM ( P = 0.9).
Conclusion: Our present data suggest that even if the type of approach to RNU was associated with different survival outcomes considering the overall population, this difference vanished when adjusted for potential confounders in propensity matching analyses. Therefore, we found that LRNU is not inferior to the ORNU approach for the treatment of UTUC.
Abbreviations: ASA: American Society of Anesthesiology; CIS: carcinoma in situ ; CSM: cancer-specific mortality; HR: hazard ratio; IQR: interquartile range; LN: lymph node; LNI: lymph node invasion; LVI: lymphovascular invasion; OM: overall mortality; pT: pathological tumour stage; RCT: randomised controlled trial; (L)(O)RNU: (laparoscopic) (open) radical nephroureterectomy; UTUC: upper tract urothelial carcinoma.
Competing Interests: The authors declare that they have no conflict of interest.
(© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)
