Publication:
Survival benefit of nephroureterectomy in systemic therapy exposed metastatic upper tract urinary urothelial carcinoma patients

dc.contributor.coauthorMorra, Simone
dc.contributor.coauthorIncesu, Reha-Baris
dc.contributor.coauthorScheipner, Lukas
dc.contributor.coauthorBaudo, Andrea
dc.contributor.coauthorJannello, Letizia Maria Ippolita
dc.contributor.coauthorSiech, Carolin
dc.contributor.coauthorde Angelis, Mario
dc.contributor.coauthorTian, Zhe
dc.contributor.coauthorCreta, Massimiliano
dc.contributor.coauthorCalifano, Gianluigi
dc.contributor.coauthorColla Ruvolo, Claudia
dc.contributor.coauthorSaad, Fred
dc.contributor.coauthorShariat, Shahrokh F.
dc.contributor.coauthorChun, Felix K. H.
dc.contributor.coauthorde Cobelli, Ottavio
dc.contributor.coauthorMusi, Gennaro
dc.contributor.coauthorBriganti, Alberto
dc.contributor.coauthorAhyai, Sascha
dc.contributor.coauthorCarmignani, Luca
dc.contributor.coauthorLongo, Nicola
dc.contributor.coauthorKarakiewicz, Pierre I.
dc.contributor.departmentN/A
dc.contributor.kuauthorTilki, Derya
dc.contributor.schoolcollegeinstituteSchool of Medicine
dc.date.accessioned2024-12-29T09:40:11Z
dc.date.issued2024
dc.description.abstractBackground It is unknown whether the stage of the primary may influence the survival (OS) of metastatic upper tract urothelial carcinoma (mUTUC) patients treated with nephroureterectomy (NU) and systemic therapy (ST). We tested this hypothesis within a large-scale North American cohort. Methods Within Surveillance Epidemiology and End Results database 2000-2020, all mUTUC patients treated with ST+NU or with ST alone were identified. Kaplan-Maier plots depicted OS. Multivariable Cox regression (MCR) models tested for differences between ST+NU and ST alone predicting overall mortality (OM). All analyses were performed in localized (T1-T2) and then repeated in locally advanced (T3-T4) patients. Results Of all 728 mUTUC patients, 187 (26%) harbored T1-T2 vs 541 (74%) harbored T3-T4. In T1-T2 patients, the median OS was 20 months in ST+NU vs 10 months in ST alone. Moreover, in MCR analyses that also relied on 3 months' landmark analyses, the combination of ST+NU independently predicted lower OM (HR 0.37, p < 0.001). Conversely, in T3-T4 patients, the median OS was 12 in ST+NU vs 10 months in ST alone. Moreover, in MCR analyses that also relied on 3 months' landmark analyses, the combination of ST+NU was not independently associated with lower OM (HR 0.85, p = 0.1). Conclusions In mUTUC patients, treated with ST, NU drastically improved survival in T1-T2 patients, even after strict methodological adjustments (multivariable and landmark analyses). However, this survival benefit did not apply to patients with locally more advanced disease (T3-T4).
dc.description.indexedbyWoS
dc.description.indexedbyScopus
dc.description.indexedbyPubMed
dc.description.issue1
dc.description.publisherscopeInternational
dc.description.volume42
dc.identifier.doi10.1007/s00345-024-05057-3
dc.identifier.eissn1433-8726
dc.identifier.issn0724-4983
dc.identifier.quartileQ1
dc.identifier.scopus2-s2.0-85194025930
dc.identifier.urihttps://doi.org/10.1007/s00345-024-05057-3
dc.identifier.urihttps://hdl.handle.net/20.500.14288/23238
dc.identifier.wos1229419900001
dc.keywordsMetastatic upper tract urothelial carcinoma
dc.keywordsPopulation-based analysis
dc.keywordsCytoreductive nephroureterectomy
dc.keywordsSystemic therapy-exposed patients
dc.languageen
dc.publisherSpringer
dc.sourceWorld Journal of Urology
dc.subjectUrology and nephrology
dc.titleSurvival benefit of nephroureterectomy in systemic therapy exposed metastatic upper tract urinary urothelial carcinoma patients
dc.typeJournal article
dspace.entity.typePublication
local.contributor.kuauthorTilki, Derya

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