Mp38-17 Real-World Management of High-Risk Upper Tract Urothelial Carcinoma: Level of Adherence to Eau-Aua Guidelines—analysis of the Robuust Registry

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP38)1 May 2024MP38-17 REAL-WORLD MANAGEMENT OF HIGH-RISK UPPER TRACT UROTHELIAL CARCINOMA: LEVEL OF ADHERENCE TO EAU-AUA GUIDELINES—ANALYSIS OF THE ROBUUST REGISTRY Gabriele Tuderti, Flavia Proietti, Zhenjie Wu, Antonio Franco, Linhui Wang, Vitaly Margulis, Raj Bhanvadia, Firas Abdollah, Marco Finati, Alessandro Antonelli, Francesco Ditonno, Nirmish Singla, Stephan Broenimann, Ithaar H. Derweesh, Dhruv Puri, Soroush Rais-Bahrami, Sol C. Moon, Matteo Ferro, Marco Tozzi, Francesco Porpiglia, Enrico Checcucci, Andreas Correa, Emma Helstrom, Mark L. Gonzalgo, Dinno F. Mendiola, Sisto Perdonà, Antonio Tufano, Benjamine M. Eilender, Reza Mehrazin, Courtney Yong, Chandru P. Sundaram, Alireza Ghoreifi, Hooman Djaladat, Riccardo Autorino, and Giuseppe Simone Gabriele TudertiGabriele Tuderti , Flavia ProiettiFlavia Proietti , Zhenjie WuZhenjie Wu , Antonio FrancoAntonio Franco , Linhui WangLinhui Wang , Vitaly MargulisVitaly Margulis , Raj BhanvadiaRaj Bhanvadia , Firas AbdollahFiras Abdollah , Marco FinatiMarco Finati , Alessandro AntonelliAlessandro Antonelli , Francesco DitonnoFrancesco Ditonno , Nirmish SinglaNirmish Singla , Stephan BroenimannStephan Broenimann , Ithaar H. DerweeshIthaar H. Derweesh , Dhruv PuriDhruv Puri , Soroush Rais-BahramiSoroush Rais-Bahrami , Sol C. MoonSol C. Moon , Matteo FerroMatteo Ferro , Marco TozziMarco Tozzi , Francesco PorpigliaFrancesco Porpiglia , Enrico CheccucciEnrico Checcucci , Andreas CorreaAndreas Correa , Emma HelstromEmma Helstrom , Mark L. GonzalgoMark L. Gonzalgo , Dinno F. MendiolaDinno F. Mendiola , Sisto PerdonàSisto Perdonà , Antonio TufanoAntonio Tufano , Benjamine M. EilenderBenjamine M. Eilender , Reza MehrazinReza Mehrazin , Courtney YongCourtney Yong , Chandru P. SundaramChandru P. Sundaram , Alireza GhoreifiAlireza Ghoreifi , Hooman DjaladatHooman Djaladat , Riccardo AutorinoRiccardo Autorino , and Giuseppe SimoneGiuseppe Simone View All Author Informationhttps://doi.org/10.1097/01.JU.0001008700.92603.b1.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The European Association of Urology (EAU) and American Urological Association (AUA) guidelines (GL) are reference cornerstones in the international urological scenario. We aimed to assess the adherence to EAU-AUA GL in a large multicenter cohort of patients with Upper Tract Urothelial Carcinoma (UTUC), treated with nephroureterectomy (NU). METHODS: A multicenter retrospective analysis utilizing the ROBUUST (ROBotic surgery for Upper tract Urothelial cancer STudy) registry was performed. We assessed the region-specific GL adherence rates for bladder cuff management, post-operative bladder instillation, performance of lymphadenectomy (LND) and adoption of adjuvant chemotherapy (AdCHT). We subsequently assessed the impact of these variables on oncologic outcomes. RESULTS: Overall, data of 2,307 patients were evaluated. Concerning bladder cuff management, strongly recommended from both GL, excision was the most adopted approach world-wide (US 88.6%, Europe (EU) 90.5%, Asia (A) 89.8%). Regarding post-operative bladder instillation, although strongly recommended in both GL, its adoption rate was only 28.4%; notably, at KM analysis patients receiving instillation did not display improved bladder recurrence-free survival (BRFS) (p=0.45). Concerning LND in high-risk disease, weakly recommended for EAU and a strongly recommended for AUA, it appears underused in both locally advanced (cT3-4: US 35.8%, EU 46.8%, A 25%) and cN positive stages (US 41.9%, EU 47.9%, A 43%); however, patients receiving LND had not any benefit in terms of cancer-specific survival (CSS); this data was homogenous across all stages (all p≥0.53). Concerning the use of AdCHT, strongly recommended in both GL for pT2-T4 and/or pN+ disease, overall administration rate was only 27.8% for pT2-T4; moreover, in pN+ disease, its overall use was 30.2%, homogeneously low across all regions. At KM analysis, patients receiving AdCHT hadn't significant CSS benefit. CONCLUSIONS: Real world data highlights poor adherence to UTUC EAU-AUA GL for most of main topics. Despite its retrospective nature, real world data seem to support the need for further research supporting clinical benefits of these intra and postoperative procedures. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e648 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Gabriele Tuderti More articles by this author Flavia Proietti More articles by this author Zhenjie Wu More articles by this author Antonio Franco More articles by this author Linhui Wang More articles by this author Vitaly Margulis More articles by this author Raj Bhanvadia More articles by this author Firas Abdollah More articles by this author Marco Finati More articles by this author Alessandro Antonelli More articles by this author Francesco Ditonno More articles by this author Nirmish Singla More articles by this author Stephan Broenimann More articles by this author Ithaar H. Derweesh More articles by this author Dhruv Puri More articles by this author Soroush Rais-Bahrami More articles by this author Sol C. Moon More articles by this author Matteo Ferro More articles by this author Marco Tozzi More articles by this author Francesco Porpiglia More articles by this author Enrico Checcucci More articles by this author Andreas Correa More articles by this author Emma Helstrom More articles by this author Mark L. Gonzalgo More articles by this author Dinno F. Mendiola More articles by this author Sisto Perdonà More articles by this author Antonio Tufano More articles by this author Benjamine M. Eilender More articles by this author Reza Mehrazin More articles by this author Courtney Yong More articles by this author Chandru P. Sundaram More articles by this author Alireza Ghoreifi More articles by this author Hooman Djaladat More articles by this author Riccardo Autorino More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...