Mp38-18 Decisional and Prognostic Impact of Diagnostic Ureteroscopy in High-Risk Upper Tract Urothelial Carcinoma: A Multi-Institutional Collaborative Analysis (Robuust Collaborative Group)

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP38)1 May 2024MP38-18 DECISIONAL AND PROGNOSTIC IMPACT OF DIAGNOSTIC URETEROSCOPY IN HIGH-RISK UPPER TRACT UROTHELIAL CARCINOMA: A MULTI-INSTITUTIONAL COLLABORATIVE ANALYSIS (ROBUUST COLLABORATIVE GROUP) Francesco Ditonno, Alessandro Veccia, Greta Pettenuzzo, Francesca Montanaro, Sonia Costantino, Antonio Franco, Firas Abdollah, Marco Finati, Giuseppe Simone, Gabriele Tuderti, Emma Helstrom, Andreas Correa, Ottavio De Cobelli, Matteo Ferro, Francesco Porpiglia, Daniele Amparore, Antonio Tufano, Sisto Perdonà, Raj Bhanvadia, Vitaly Margulis, Stephan Bronimann, Nirmish Singla, Margaret F. Meagher, Ithaar H. Derweesh, Dinno F. Mendiola, Mark L. Gonzalgo, Benjamine M. Eilender, Reza Mehrazin, Sol C. Moon, Soroush Rais-Bahrami, Courtney Young, Chandru P. Sundaram, Farshad Sheybaee Moghaddam, Alireza Ghoreifi, Hooman Djaladat, Linhui Wang, Zhenjie Wu, Riccardo Autorino, and Alessandro Antonelli Francesco DitonnoFrancesco Ditonno , Alessandro VecciaAlessandro Veccia , Greta PettenuzzoGreta Pettenuzzo , Francesca MontanaroFrancesca Montanaro , Sonia CostantinoSonia Costantino , Antonio FrancoAntonio Franco , Firas AbdollahFiras Abdollah , Marco FinatiMarco Finati , Giuseppe SimoneGiuseppe Simone , Gabriele TudertiGabriele Tuderti , Emma HelstromEmma Helstrom , Andreas CorreaAndreas Correa , Ottavio De CobelliOttavio De Cobelli , Matteo FerroMatteo Ferro , Francesco PorpigliaFrancesco Porpiglia , Daniele AmparoreDaniele Amparore , Antonio TufanoAntonio Tufano , Sisto PerdonàSisto Perdonà , Raj BhanvadiaRaj Bhanvadia , Vitaly MargulisVitaly Margulis , Stephan BronimannStephan Bronimann , Nirmish SinglaNirmish Singla , Margaret F. MeagherMargaret F. Meagher , Ithaar H. DerweeshIthaar H. Derweesh , Dinno F. MendiolaDinno F. Mendiola , Mark L. GonzalgoMark L. Gonzalgo , Benjamine M. EilenderBenjamine M. Eilender , Reza MehrazinReza Mehrazin , Sol C. MoonSol C. Moon , Soroush Rais-BahramiSoroush Rais-Bahrami , Courtney YoungCourtney Young , Chandru P. SundaramChandru P. Sundaram , Farshad Sheybaee MoghaddamFarshad Sheybaee Moghaddam , Alireza GhoreifiAlireza Ghoreifi , Hooman DjaladatHooman Djaladat , Linhui WangLinhui Wang , Zhenjie WuZhenjie Wu , Riccardo AutorinoRiccardo Autorino , and Alessandro AntonelliAlessandro Antonelli View All Author Informationhttps://doi.org/10.1097/01.JU.0001008700.92603.b1.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current guidelines strongly recommend against the use of diagnostic ureteroscopy (URS) in the diagnostic pathway for upper tract urothelial carcinoma (UTUC). We aimed at analysing the decision-making and prognostic role of diagnostic URS in high-risk patients undergoing radical nephroureterectomy (RNU). METHODS: Data were retrieved from the ROBUUST (ROBotic surgery for Upper tract Urothelial cancer STudy) multicenter international (2015-2022) dataset. A retrospective comparative analysis was conducted to evaluate the characteristics of high-risk patients who either underwent pre-operative URS and biopsy before RNU or did not, and its impact on surgical and oncological outcomes. Survival analysis included recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS). Cox proportional hazard model was used to evaluate significant predictors of time-to-event outcomes. Logistic regression analysis was performed to evaluate differences between patients receiving URS and, based on their URS status, to determine their likelihood of receiving kidney-sparing surgery and a specific surgical approach. RESULTS: Overall, 1,912 patients were included, 1,035 undergoing URS and biopsy and 877 not receiving endoscopic diagnosis prior to RNU. A mean follow-up of 28.9 months was obtained. Patients undergoing pre-operative URS were more likely female (OR 0.67, 95% CI 0.51-0.87), with smaller (OR 0.31, 95% CI 0.22-0.43), and organ-confined tumors (OR 0.47, 95% CI 0.34-0.64), compared to patients not receiving URS. Robot-assisted RNU was the most common procedure (55.1%), in both subgroups. At survival analysis, CSS was significantly higher for patients undergoing URS (37 months vs 20 months, p<.001). However, the two cohorts were comparable in terms of RFS (p=.6), MFS (p=.3) and OS (p=.07). In Cox regression analysis, URS was not a significant predictor of worse oncological outcomes for each time-to-event outcome. Likewise, in logistic regression analysis, pre-operative ureteroscopy was not a significant predictor of a certain surgical approach or technique. CONCLUSIONS: Diagnostic ureteroscopy is performed mostly in patients with smaller localized tumors. Patients undergoing ureteroscopy had a longer CSS, even though statistical significance was lost at Cox analysis. Surgical strategy is likely determined more by tumour pathology features than by ureteroscopy findings. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e649 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Francesco Ditonno More articles by this author Alessandro Veccia More articles by this author Greta Pettenuzzo More articles by this author Francesca Montanaro More articles by this author Sonia Costantino More articles by this author Antonio Franco More articles by this author Firas Abdollah More articles by this author Marco Finati More articles by this author Giuseppe Simone More articles by this author Gabriele Tuderti More articles by this author Emma Helstrom More articles by this author Andreas Correa More articles by this author Ottavio De Cobelli More articles by this author Matteo Ferro More articles by this author Francesco Porpiglia More articles by this author Daniele Amparore More articles by this author Antonio Tufano More articles by this author Sisto Perdonà More articles by this author Raj Bhanvadia More articles by this author Vitaly Margulis More articles by this author Stephan Bronimann More articles by this author Nirmish Singla More articles by this author Margaret F. Meagher More articles by this author Ithaar H. Derweesh More articles by this author Dinno F. Mendiola More articles by this author Mark L. Gonzalgo More articles by this author Benjamine M. Eilender More articles by this author Reza Mehrazin More articles by this author Sol C. Moon More articles by this author Soroush Rais-Bahrami More articles by this author Courtney Young More articles by this author Chandru P. Sundaram More articles by this author Farshad Sheybaee Moghaddam More articles by this author Alireza Ghoreifi More articles by this author Hooman Djaladat More articles by this author Linhui Wang More articles by this author Zhenjie Wu More articles by this author Riccardo Autorino More articles by this author Alessandro Antonelli More articles by this author Expand All Advertisement PDF downloadLoading ...