Is Segmental Ureterectomy Associated with Inferior Survival for Localized Upper-Tract Urothelial Carcinoma of the Ureter Compared to Radical Nephroureterectomy?
Segmental ureterectomy (SU) is an alternative to radical nephroureterectomy (RNU) in the treatment of upper-tract urothelial carcinoma (UTUC) of the ureter. SU generally preserves renal function, at the expense of less intensive cancer control. We aim to assess whether SU is associated with inferior...
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| Veröffentlicht in: | Cancers 2023-02, Vol.15 (5), p.1373 |
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| creator | Paciotti, Marco Alkhatib, Khalid Y Nguyen, David-Dan Yim, Kendrick Lipsitz, Stuart R Mossanen, Matthew Casale, Paolo Pierorazio, Phillip M Kibel, Adam S Trinh, Quoc-Dien Buffi, Nicoló Maria Lughezzani, Giovanni Cole, Alexander P |
| description | Segmental ureterectomy (SU) is an alternative to radical nephroureterectomy (RNU) in the treatment of upper-tract urothelial carcinoma (UTUC) of the ureter. SU generally preserves renal function, at the expense of less intensive cancer control. We aim to assess whether SU is associated with inferior survival compared to RNU. Using the National Cancer Database (NCDB), we identified patients diagnosed with localized UTUC of the ureter between 2004-2015. We used a propensity-score-overlap-weighted (PSOW) multivariable survival model to compare survival following SU vs. RNU. PSOW-adjusted Kaplan-Meier curves were generated and we performed a non-inferiority test of overall survival. A population of 13,061 individuals with UTUC of the ureter receiving either SU or RNU was identified; of these, 9016 underwent RNU and 4045 SU. Factors associated with decreased likelihood of receiving SU were female gender (OR, 0.81; 95% CI, 0.75-0.88;
< 0.001), advanced clinical T stage (cT4) (OR, 0.51; 95% CI, 0.30-0.88;
= 0.015), and high-grade tumor (OR, 0.76; 95% CI, 0.67-0.86;
< 0.001). Age greater than 79 years was associated with increased probability of undergoing SU (OR, 1.18; 95% CI, 1.00-1.38;
= 0.047). There was no statistically significant difference in OS between SU and RNU (HR, 0.98; 95% CI, 0.93-1.04;
= 0.538). SU was not inferior to RNU in PSOW-adjusted Cox regression analysis (
< 0.001 for non-inferiority). In weighted cohorts of individuals with UTUC of the ureter, the use of SU was not associated with inferior survival compared to RNU. Urologists should continue to utilize SU in appropriately selected patients. |
| doi_str_mv | 10.3390/cancers15051373 |
| format | Article |
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< 0.001), advanced clinical T stage (cT4) (OR, 0.51; 95% CI, 0.30-0.88;
= 0.015), and high-grade tumor (OR, 0.76; 95% CI, 0.67-0.86;
< 0.001). Age greater than 79 years was associated with increased probability of undergoing SU (OR, 1.18; 95% CI, 1.00-1.38;
= 0.047). There was no statistically significant difference in OS between SU and RNU (HR, 0.98; 95% CI, 0.93-1.04;
= 0.538). SU was not inferior to RNU in PSOW-adjusted Cox regression analysis (
< 0.001 for non-inferiority). In weighted cohorts of individuals with UTUC of the ureter, the use of SU was not associated with inferior survival compared to RNU. Urologists should continue to utilize SU in appropriately selected patients.</description><identifier>ISSN: 2072-6694</identifier><identifier>EISSN: 2072-6694</identifier><identifier>DOI: 10.3390/cancers15051373</identifier><identifier>PMID: 36900166</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Adenocarcinoma ; Bladder ; Cancer therapies ; Care and treatment ; Chemotherapy ; Diseases ; Histology ; Patients ; Regression analysis ; Renal function ; Statistical analysis ; Surgery ; Survival ; Ureter ; Urinary organs ; Urothelial carcinoma ; Urothelium ; Variables ; Women</subject><ispartof>Cancers, 2023-02, Vol.15 (5), p.1373</ispartof><rights>COPYRIGHT 2023 MDPI AG</rights><rights>2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 by the authors. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c489t-c9b44025ae93abc357d1a218a7a1765a4e4861aea52229fb2476d7cf5755a0ff3</citedby><cites>FETCH-LOGICAL-c489t-c9b44025ae93abc357d1a218a7a1765a4e4861aea52229fb2476d7cf5755a0ff3</cites><orcidid>0000-0002-6008-0503</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10000204/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10000204/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36900166$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Paciotti, Marco</creatorcontrib><creatorcontrib>Alkhatib, Khalid Y</creatorcontrib><creatorcontrib>Nguyen, David-Dan</creatorcontrib><creatorcontrib>Yim, Kendrick</creatorcontrib><creatorcontrib>Lipsitz, Stuart R</creatorcontrib><creatorcontrib>Mossanen, Matthew</creatorcontrib><creatorcontrib>Casale, Paolo</creatorcontrib><creatorcontrib>Pierorazio, Phillip M</creatorcontrib><creatorcontrib>Kibel, Adam S</creatorcontrib><creatorcontrib>Trinh, Quoc-Dien</creatorcontrib><creatorcontrib>Buffi, Nicoló Maria</creatorcontrib><creatorcontrib>Lughezzani, Giovanni</creatorcontrib><creatorcontrib>Cole, Alexander P</creatorcontrib><title>Is Segmental Ureterectomy Associated with Inferior Survival for Localized Upper-Tract Urothelial Carcinoma of the Ureter Compared to Radical Nephroureterectomy?</title><title>Cancers</title><addtitle>Cancers (Basel)</addtitle><description>Segmental ureterectomy (SU) is an alternative to radical nephroureterectomy (RNU) in the treatment of upper-tract urothelial carcinoma (UTUC) of the ureter. SU generally preserves renal function, at the expense of less intensive cancer control. We aim to assess whether SU is associated with inferior survival compared to RNU. Using the National Cancer Database (NCDB), we identified patients diagnosed with localized UTUC of the ureter between 2004-2015. We used a propensity-score-overlap-weighted (PSOW) multivariable survival model to compare survival following SU vs. RNU. PSOW-adjusted Kaplan-Meier curves were generated and we performed a non-inferiority test of overall survival. A population of 13,061 individuals with UTUC of the ureter receiving either SU or RNU was identified; of these, 9016 underwent RNU and 4045 SU. Factors associated with decreased likelihood of receiving SU were female gender (OR, 0.81; 95% CI, 0.75-0.88;
< 0.001), advanced clinical T stage (cT4) (OR, 0.51; 95% CI, 0.30-0.88;
= 0.015), and high-grade tumor (OR, 0.76; 95% CI, 0.67-0.86;
< 0.001). Age greater than 79 years was associated with increased probability of undergoing SU (OR, 1.18; 95% CI, 1.00-1.38;
= 0.047). There was no statistically significant difference in OS between SU and RNU (HR, 0.98; 95% CI, 0.93-1.04;
= 0.538). SU was not inferior to RNU in PSOW-adjusted Cox regression analysis (
< 0.001 for non-inferiority). In weighted cohorts of individuals with UTUC of the ureter, the use of SU was not associated with inferior survival compared to RNU. Urologists should continue to utilize SU in appropriately selected patients.</description><subject>Adenocarcinoma</subject><subject>Bladder</subject><subject>Cancer therapies</subject><subject>Care and treatment</subject><subject>Chemotherapy</subject><subject>Diseases</subject><subject>Histology</subject><subject>Patients</subject><subject>Regression analysis</subject><subject>Renal function</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Survival</subject><subject>Ureter</subject><subject>Urinary organs</subject><subject>Urothelial carcinoma</subject><subject>Urothelium</subject><subject>Variables</subject><subject>Women</subject><issn>2072-6694</issn><issn>2072-6694</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNptkktvEzEQx1cIRKvSMzdkiQuXtH6s19lTVUU8IkUg0eZsTbzjxNXuerE3QeXT8FGZqKGkFfbB9vg3_3loiuKt4BdK1fzSQe8wZaG5FsqoF8Wp5EZOqqouXx7dT4rznO84LaWEqczr4kRVNeeiqk6L3_PMbnDdYT9Cy5YJR0zoxtjds-ucowswYsN-hnHD5r3HFGJiN9u0CzvCPT0W0UEbfhG0HAZMk9sEbiShOG6wDQTNILnQxw5Y9IyMhyBsFrsBEvmNkX2HJpAM-4rDJsXtURZXb4pXHtqM54fzrFh--ng7-zJZfPs8n10vJq6c1uPE1auy5FID1gpWTmnTCJBiCgaoZg0lltNKAIKWUtZ-JUtTNcZ5bbQG7r06K64edIftqsPGUUMStHZIoYN0byME-_SnDxu7jjsr9p2VvCSFDweFFH9sMY-2C9lh20KPcZutNJQB57pShL5_ht5R1T3Vt6e0MFNTVv-oNbRoQ-8jBXZ7UXttSmFUXUtD1MV_KNoNdsHFHn0g-xOHywcHl2LOCf1jkYLb_WDZZ4NFHu-Oe_PI_x0j9QeoiMyh</recordid><startdate>20230221</startdate><enddate>20230221</enddate><creator>Paciotti, Marco</creator><creator>Alkhatib, Khalid Y</creator><creator>Nguyen, David-Dan</creator><creator>Yim, Kendrick</creator><creator>Lipsitz, Stuart R</creator><creator>Mossanen, Matthew</creator><creator>Casale, Paolo</creator><creator>Pierorazio, Phillip M</creator><creator>Kibel, Adam S</creator><creator>Trinh, Quoc-Dien</creator><creator>Buffi, Nicoló Maria</creator><creator>Lughezzani, Giovanni</creator><creator>Cole, Alexander P</creator><general>MDPI AG</general><general>MDPI</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7TO</scope><scope>7XB</scope><scope>8FE</scope><scope>8FH</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>LK8</scope><scope>M2O</scope><scope>M7P</scope><scope>MBDVC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6008-0503</orcidid></search><sort><creationdate>20230221</creationdate><title>Is Segmental Ureterectomy Associated with Inferior Survival for Localized Upper-Tract Urothelial Carcinoma of the Ureter Compared to Radical Nephroureterectomy?</title><author>Paciotti, Marco ; Alkhatib, Khalid Y ; Nguyen, David-Dan ; Yim, Kendrick ; Lipsitz, Stuart R ; Mossanen, Matthew ; Casale, Paolo ; Pierorazio, Phillip M ; Kibel, Adam S ; Trinh, Quoc-Dien ; Buffi, Nicoló Maria ; Lughezzani, Giovanni ; Cole, Alexander P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c489t-c9b44025ae93abc357d1a218a7a1765a4e4861aea52229fb2476d7cf5755a0ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adenocarcinoma</topic><topic>Bladder</topic><topic>Cancer therapies</topic><topic>Care and treatment</topic><topic>Chemotherapy</topic><topic>Diseases</topic><topic>Histology</topic><topic>Patients</topic><topic>Regression analysis</topic><topic>Renal function</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Survival</topic><topic>Ureter</topic><topic>Urinary organs</topic><topic>Urothelial carcinoma</topic><topic>Urothelium</topic><topic>Variables</topic><topic>Women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Paciotti, Marco</creatorcontrib><creatorcontrib>Alkhatib, Khalid Y</creatorcontrib><creatorcontrib>Nguyen, David-Dan</creatorcontrib><creatorcontrib>Yim, Kendrick</creatorcontrib><creatorcontrib>Lipsitz, Stuart R</creatorcontrib><creatorcontrib>Mossanen, Matthew</creatorcontrib><creatorcontrib>Casale, Paolo</creatorcontrib><creatorcontrib>Pierorazio, Phillip M</creatorcontrib><creatorcontrib>Kibel, Adam S</creatorcontrib><creatorcontrib>Trinh, Quoc-Dien</creatorcontrib><creatorcontrib>Buffi, Nicoló Maria</creatorcontrib><creatorcontrib>Lughezzani, Giovanni</creatorcontrib><creatorcontrib>Cole, Alexander P</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Research Library</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cancers</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Paciotti, Marco</au><au>Alkhatib, Khalid Y</au><au>Nguyen, David-Dan</au><au>Yim, Kendrick</au><au>Lipsitz, Stuart R</au><au>Mossanen, Matthew</au><au>Casale, Paolo</au><au>Pierorazio, Phillip M</au><au>Kibel, Adam S</au><au>Trinh, Quoc-Dien</au><au>Buffi, Nicoló Maria</au><au>Lughezzani, Giovanni</au><au>Cole, Alexander P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is Segmental Ureterectomy Associated with Inferior Survival for Localized Upper-Tract Urothelial Carcinoma of the Ureter Compared to Radical Nephroureterectomy?</atitle><jtitle>Cancers</jtitle><addtitle>Cancers (Basel)</addtitle><date>2023-02-21</date><risdate>2023</risdate><volume>15</volume><issue>5</issue><spage>1373</spage><pages>1373-</pages><issn>2072-6694</issn><eissn>2072-6694</eissn><abstract>Segmental ureterectomy (SU) is an alternative to radical nephroureterectomy (RNU) in the treatment of upper-tract urothelial carcinoma (UTUC) of the ureter. SU generally preserves renal function, at the expense of less intensive cancer control. We aim to assess whether SU is associated with inferior survival compared to RNU. Using the National Cancer Database (NCDB), we identified patients diagnosed with localized UTUC of the ureter between 2004-2015. We used a propensity-score-overlap-weighted (PSOW) multivariable survival model to compare survival following SU vs. RNU. PSOW-adjusted Kaplan-Meier curves were generated and we performed a non-inferiority test of overall survival. A population of 13,061 individuals with UTUC of the ureter receiving either SU or RNU was identified; of these, 9016 underwent RNU and 4045 SU. Factors associated with decreased likelihood of receiving SU were female gender (OR, 0.81; 95% CI, 0.75-0.88;
< 0.001), advanced clinical T stage (cT4) (OR, 0.51; 95% CI, 0.30-0.88;
= 0.015), and high-grade tumor (OR, 0.76; 95% CI, 0.67-0.86;
< 0.001). Age greater than 79 years was associated with increased probability of undergoing SU (OR, 1.18; 95% CI, 1.00-1.38;
= 0.047). There was no statistically significant difference in OS between SU and RNU (HR, 0.98; 95% CI, 0.93-1.04;
= 0.538). SU was not inferior to RNU in PSOW-adjusted Cox regression analysis (
< 0.001 for non-inferiority). In weighted cohorts of individuals with UTUC of the ureter, the use of SU was not associated with inferior survival compared to RNU. Urologists should continue to utilize SU in appropriately selected patients.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>36900166</pmid><doi>10.3390/cancers15051373</doi><orcidid>https://orcid.org/0000-0002-6008-0503</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MDPI - Multidisciplinary Digital Publishing Institute; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; PubMed Central Open Access |
| subjects | Adenocarcinoma Bladder Cancer therapies Care and treatment Chemotherapy Diseases Histology Patients Regression analysis Renal function Statistical analysis Surgery Survival Ureter Urinary organs Urothelial carcinoma Urothelium Variables Women |
| title | Is Segmental Ureterectomy Associated with Inferior Survival for Localized Upper-Tract Urothelial Carcinoma of the Ureter Compared to Radical Nephroureterectomy? |
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