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Changes in the Perioperative Management and Outcomes of Patients With Upper Tract Urothelial Carcinoma Undergoing Radical Nephroureterectomy at Memorial Sloan Kettering Cancer Center: Over 20 Years of Experience.

Authors :
Yip W
Assel MJ
Wong NC
Tracey AT
Alvim RG
Nogueira L
Almassi N
Singla N
Clinton TN
Sjoberg DD
Al-Ahmadie H
Hakimi AA
Pietzak EJ
Cha EK
Donahue TF
Dalbagni G
Bochner BH
Bajorin DF
Coleman JA
Source :
Urology practice [Urol Pract] 2024 Mar; Vol. 11 (2), pp. 356-366. Date of Electronic Publication: 2024 Feb 02.
Publication Year :
2024

Abstract

Introduction: We evaluated surgical trends, perioperative management evolution, and oncologic outcomes in patients who underwent radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) at a tertiary cancer center over a 24-year period.<br />Methods: Between 1995 and 2018, we evaluated 743 consecutive patients with UTUC who underwent RNU. Generalized additive models were used to estimate the associations between date of surgery and continuous outcomes using a linear model, dichotomous outcomes using a logit link, categorical outcomes using multinomial models, and 2- and 5-year survival outcomes using Cox proportional hazards models.<br />Results: Over the study period, preoperative diagnostic endoscopic biopsies increased from 10% to 66%, along with the proportion of patients who underwent RNU for high-grade disease from 55% to 91%. The rate of open RNU declined from 100% to 56% with a rise in minimally invasive approaches. Median lymph node yield increased with more retroperitoneal lymph node dissections performed. Neoadjuvant chemotherapy utilization increased with a contemporary utilization rate of 32%, coinciding with an increase in pT0 rate from 2% to 8%. Cancer-specific survival probabilities improved over the study period, while metastasis-free and overall survival remained stable.<br />Conclusions: We found several changes in treatment patterns and outcomes for patients with UTUC over the past 2 decades. How individual alterations in management factors, such as patient selection, perioperative chemotherapy, lymphadenectomy, and salvage therapies, impact patient outcomes is challenging in the setting of multiple overlapping practice changes for this rare disease and warrants further investigation.

Details

Language :
English
ISSN :
2352-0787
Volume :
11
Issue :
2
Database :
MEDLINE
Journal :
Urology practice
Publication Type :
Academic Journal
Accession number :
38315829
Full Text :
https://doi.org/10.1097/UPJ.0000000000000507