The Long-Term Functional and Oncologic Outcomes of Kidney-Sparing Surgery in Upper Tract Urothelial Carcinoma

Yu-Chieh Wang; Jian-Ri Li; Chuan-Shu Chen; Shian-Shiang Wang; Cheng-Kuang Yang; Kun-Yuan Chiu; Chiann-Yi Hsu

doi:10.1245/s10434-024-16523-y

The Long-Term Functional and Oncologic Outcomes of Kidney-Sparing Surgery in Upper Tract Urothelial Carcinoma

Ann Surg Oncol. 2024 Nov 16. doi: 10.1245/s10434-024-16523-y. Online ahead of print.

Authors

Yu-Chieh Wang^#^{1

2}, Jian-Ri Li^#^{3

4

5}, Chuan-Shu Chen^{6

7

8}, Shian-Shiang Wang^{3

4

9

10}, Cheng-Kuang Yang³, Kun-Yuan Chiu^{3

10}, Chiann-Yi Hsu¹¹

Affiliations

¹ Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.
² School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.
³ Department of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
⁴ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC.
⁵ College of Nursing, Hung-Kuang University, Taichung, Taiwan.
⁶ Department of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan. v2060d@yahoo.com.
⁷ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC. v2060d@yahoo.com.
⁸ Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. v2060d@yahoo.com.
⁹ Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
¹⁰ Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan.
¹¹ Biostatistics Group, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.

^# Contributed equally.

PMID: 39550482
DOI: 10.1245/s10434-024-16523-y

Abstract

Background: This study investigated the utilization of kidney-sparing surgery (KSS) as an alternative option to radical nephroureterectomy (RNU) in managing upper urinary tract urothelial carcinoma (UTUC) patients.

Objective: Our study aimed to compare the functional outcomes and oncological outcomes between KSS and RNU.

Material and methods: We retrospectively analyzed 252 patients with UTUC without clinical node positivity or metastasis who had been treated with either RNU or KSS. We collected information on each patient, including clinicopathological factors, renal function variations, and oncological outcomes. Hemodialysis-free survival (HDFS), stage 4 chronic kidney disease (CKD4) progression-free survival (PFS), recurrence-free survival (RFS), and overall survival (OS) were assessed using inverse probability of treatment weighting (IPTW)-weighted Kaplan-Meier analysis. The hazard ratio for oncological and functional outcomes of KSS was analyzed using the Cox proportional hazards model.

Results: The OS at 8 years was 77.06% (RNU) and 70.59% (KSS) and did not significantly differ between the two groups (p = 0.691), although the KSS group experienced a higher recurrence rate. Functional outcomes indicated no significant difference in postoperative renal function at 1 year; however, KSS was associated with better preservation of renal function (23.44% vs. 28.23%), albeit not statistically significant (p = 0.055). Kaplan-Meier analysis revealed no significant disparities in CKD4 PFS between the KSS and RNU groups involved in the study (p = 0.089), although the KSS group displayed poorer HDFS than the RNU group (p = 0.001).

Conclusion: KSS had no compromising survival outcomes when compared with RNU, not only in low-risk patients but also in high-risk patients with a normal contralateral kidney. The efficacy of renal function preservation was presented in this study, however the results were below our expectations.

Keywords: Functional outcomes; Nephroureterectomy; Oncological outcomes; Organ-sparing treatment; Transitional cell carcinoma; Upper tract urothelial carcinoma.