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Kidney sparing surgery in upper tract urothelial carcinoma: paradigm change in surgical treatment for ureter cancer

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Abstract

Purpose

To extend the indications of kidney-sparing surgery (KSS) for ureter cancer by comparing the oncological outcomes between patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU) or KSS.

Methods

We retrospectively reviewed 708 patients with UTUC who underwent RNU (N = 646) or KSS (N = 62) between 2011 and 2019 to analyze the oncologic outcomes and prognostic factors. Subgroup analyses were performed for patients with unifocal ureteral urothelial carcinoma (UC).

Results

No significant difference was observed in the overall survival (OS) or cancer-specific survival (CSS) between RNU and KSS (distal ureterectomy with reimplantation (N = 33), ureterectomy with ileal ureter (N = 14), ureteroscopic tumor resection (N = 10), and ureterectomy with ureteroureterostomy (N = 5)). Among 269 (38.0%) patients with unifocal ureteral UC, 219 and 50 patients underwent RNU and KSS, respectively. OS and CSS were not significantly different between these two groups. Pathologic stage was a significant risk factor in multivariate analysis (hazard ratio = 2.621; p = 0.000). Among 646 RNU patients, 219 (33.9%) had unifocal ureteral UC, 40 (18.3%) with low-grade tumors. Among these, 13 (5.9%) patients with unifocal, low-grade and small (< 2 cm) tumors received nephroureterectomy.

Conclusion

Kidney-sparing surgery should be regarded as an important alternative to RNU for patients with unifocal ureteral UC thought to have noninvasive disease to preserve renal function and reduce overtreatment.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

We did not receive any specific grant or funding for this research from agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 43 Gil 88, Olympic-Road, Songpa-Gu, 05505, Seoul, Republic of Korea

    Dongsu Kim, Dalsan You, In Gab Jeong, Jun Hyuk Hong, Hanjong Ahn & Bumsik Hong

Authors
  1. Dongsu Kim
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  2. Dalsan You
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  3. In Gab Jeong
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  4. Jun Hyuk Hong
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  5. Hanjong Ahn
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  6. Bumsik Hong
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Contributions

The study conception and design were conducted by DK and BH. All authors contributed to the material preparation, data collection and analysis. DK performed the statistical analysis. The first draft of the manuscript was written by DK, and all authors commented on the previous versions of the manuscript and made critical revisions. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bumsik Hong.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Asan Medical Center (08/19/2022, IRB No: S2022-1762-0001).

Ethics statement

This material is the authors’ original work, which has not been previously published elsewhere. This paper is not currently being considered for publication elsewhere. This paper reflects the authors’ original research and analysis in a truthful and complete manner. This paper properly credits the meaningful contributions of the co-authors and co-researchers. All authors have been personally and actively involved in substantial work leading to the production of this paper and will take public responsibility for its content.

Consent to participate

The institutional ethics board approved this study, and informed consent was waived.

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Not applicable.

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Dongsu Kim is the first author.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary Figure 1. Survival of patients with large (≥2 cm) unifocal ureteral urothelial carcinoma

432_2023_5207_MOESM2_ESM.jpg

Supplementary Figure 2. Survival of patients with large (≥ 2 cm) unifocal ureteral urothelial carcinoma after propensity score matching

432_2023_5207_MOESM3_ESM.jpg

Supplementary Figure 3. Receiver-operating characteristics curve (AUROC) of the proportion with an ipsilateral kidney to predict noninvasive upper tract urothelial carcinoma

432_2023_5207_MOESM4_ESM.jpg

Supplementary Figure 4. Survival of patients who underwent kidney-sparing surgery, comparing ileal ureter with all others

Supplementary Figure 5. Survival of patients with pT3/T4 unifocal ureteral urothelial carcinoma

Supplementary file6 (DOCX 18 KB)

Supplementary file7 (DOCX 17 KB)

Supplementary file8 (DOCX 18 KB)

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Kim, D., You, D., Jeong, I.G. et al. Kidney sparing surgery in upper tract urothelial carcinoma: paradigm change in surgical treatment for ureter cancer. J Cancer Res Clin Oncol 149, 13717–13725 (2023). https://doi.org/10.1007/s00432-023-05207-x

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