Articles

Platinum Priority – Urothelial Cancer
Editorial by Alexandre R. Zlotta on pp. 970–972 of this issueEditorial by Alexandre R. Zlotta on pp. 970–972 of this issue

Should Bladder Cuff Excision Remain the Standard of Care at Nephroureterectomy in Patients with Urothelial Carcinoma of the Renal Pelvis? A Population-based Study

By: Giovanni Lughezzania b 1, Maxine Suna 1, Paul Perrottec, Shahrokh F. Shariata, Claudio Jeldresa, Lars Budausa d, Ahmed Alaskera, Alain Duclosc, Hugues Widmerc, Mathieu Latoure, Giorgio Guazzonib, Francesco Montorsib and Pierre I. Karakiewicza c lowast

European Urology, Volume 57 Issue 1, June 2010, Pages 956-962

Published online: 01 June 2010

Keywords: Urothelial carcinoma, Upper urinary tract, Nephroureterectomy, Survival

Abstract Full Text Full Text PDF (352 KB)

Abstract

Background

A large, multi-institutional, tertiary care center study suggested no benefit from bladder cuff excision (BCE) at nephroureterectomy in patients with upper tract urothelial carcinoma (UC).

Objective

We tested and quantified the prognostic impact of BCE at nephroureterectomy on cancer-specific mortality (CSM) in a large population-based cohort of patients with UC of the renal pelvis.

Design, setting, and participants

A cohort of 4210 patients with UC of the renal pelvis were treated with nephroureterectomy with (NUC) or without (NU) a BCE between 1988 and 2006 within 17 Surveillance, Epidemiology, and End Results registries.

Measurements

Cumulative incidence plots and competing risks regression models compared CSM after either NUC or NU. Covariates consisted of pathologic T and N stages, grade, age, year of surgery, gender, and race.

Results and limitations

Respectively, 2492 (59.2%) and 1718 (40.8%) patients underwent a nephroureterectomy with or without BCE. In univariable and multivariable analyses, BCE omission increased CSM rates in patients with pT3N0/x, pT4N0/x, and pT(any)N1-3 UC of the renal pelvis. For example, in patients with pT3N0/x disease, holding all other variables constant, BCE omission increased CSM in a 1.25-fold fashion (p=0.04). Similarly, in patients with pT4N0/x disease, BCE omission resulted in a 1.45-fold increase (p=0.02). The main limitation of our study is the lack of data on disease recurrence.

Conclusions

Nephroureterectomy with BCE remains the standard of care in the treatment of UC of the renal pelvis and should invariably be performed in patients with locally advanced disease. Conversely, patients with pT1 and pT2 disease could be considered for NU without compromising CSM. However, recurrence data are needed to fully confirm the validity of this option.

Take Home Message

A bladder cuff excision at nephroureterectomy may be avoided in patients with localized upper tract urothelial cancers. Conversely, a bladder cuff excision should invariably be performed in patients with locally advanced disease.

Keywords: Urothelial carcinoma, Upper urinary tract, Nephroureterectomy, Survival.

Footnotes

a Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada

b Department of Urology, Vita-Salute San Raffaele University, Milan, Italy

c Department of Urology, University of Montreal, Montreal, Québec, Canada

d Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany

e Department of Pathology, University of Montreal, Montreal, Québec, Canada

lowast Corresponding author. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), 1058, rue St-Denis, Montréal, Québec, Canada, H2X 3J4. Tel. +1 514 890 8000 35336; Fax: +1 514 227 5103.

1 These authors contributed equally to the manuscript.

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