Decisional and prognostic impact of diagnostic ureteroscopy in high-risk upper tract urothelial carcinoma: A multi-institutional collaborative analysis (ROBUUST collaborative group)

• Published in: Urologic oncology Vol. 42; no. 9; pp. 290.e1 - 290.e9
• Main Authors: Ditonno, Francesco, Franco, Antonio, Veccia, Alessandro, Bertolo, Riccardo, Wu, Zhenjie, Wang, Linhui, Abdollah, Firas, Finati, Marco, Simone, Giuseppe, Tuderti, Gabriele, Helstrom, Emma, Correa, Andres, De Cobelli, Ottavio, Ferro, Matteo, Porpiglia, Francesco, Amparore, Daniele, Tufano, Antonio, Perdonà, Sisto, Bhanvadia, Raj, Margulis, Vitaly, Brönimann, Stephan, Singla, Nirmish, Puri, Dhruv, Derweesh, Ithaar H., Mendiola, Dinno F., Gonzalgo, Mark L., Ben-David, Reuben, Mehrazin, Reza, Moon, Sol C., Rais-Bahrami, Soroush, Yong, Courtney, Sundaram, Chandru P., Moghaddam, Farshad Sheybaee, Ghoreifi, Alireza, Djaladat, Hooman, Autorino, Riccardo, Antonelli, Alessandro
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2024
• Subjects: Aged; Carcinoma, Transitional Cell - diagnosis; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; Clinical Decision-Making; Diagnostic ureteroscopy; Female; Humans; Kidney Neoplasms - diagnosis; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Kidney-sparing surgery; Male; Middle Aged; Nephroureterectomy; Prognosis; Retrospective Studies; Upper tract urothelial carcinoma; Ureteral Neoplasms - diagnosis; Ureteral Neoplasms - mortality; Ureteral Neoplasms - pathology; Ureteral Neoplasms - surgery; Ureteroscopy - methods; Nephroureterectomy; Diagnostic ureteroscopy; Upper tract urothelial carcinoma; Kidney-sparing surgery
• ISSN: 1078-1439; 1873-2496; 1873-2496
• DOI: 10.1016/j.urolonc.2024.04.021

•A total of 1,912 high-risk UTUC patients from the ROBUUST dataset were analyzed, of which 1,035 patients underwent ureteroscopy (URS) and biopsy and 877 patients did not.•The concordance between preoperative biopsy and final histology for tumor grade was 80.1%.•No difference in RFS or MFS between URS and non-URS groups, with a significantly higher CSS and OS in the URS group.•Survival benefits in OS and CSS suggest URS contributes to better patient selection for curative surgery.•Diagnostic URS is effective in high-risk UTUC management, aiding diagnosis, and treatment decisions. Diagnostic ureteroscopy (URS) with or without biopsy remains a subject of contention in the management of upper tract urothelial carcinoma (UTUC), with varying recommendations across different guidelines. The study aims to analyse the decision-making and prognostic role of diagnostic ureteroscopy (URS) in high-risk UTUC patients undergoing curative surgery. In this retrospective multi-institutional analysis of high-risk UTUC patients from the ROBUUST dataset, a comparison between patients who received or not preoperative URS and biopsy before curative surgery was carried out. Logistic regression analysis evaluated differences between patients receiving URS and its impact on treatment strategy. Survival analysis included 5-year recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS). After adjusting for high-risk prognostic group features, Cox proportional hazard model estimated significant predictors of time-to-event outcomes. Overall, 1,912 patients were included, 1,035 with preoperative URS and biopsy and 877 without. Median follow-up: 24 months. Robot-assisted radical nephroureterectomy was the most common procedure (55.1%), in both subgroups. The 5-year OS (P = 0.04) and CSS (P < 0.001) were significantly higher for patients undergoing URS. The 5-year RFS (P = 0.6), and MFS (P = 0.3) were comparable between the 2 groups. Preoperative URS and biopsy were neither a significant predictor of worse oncological outcomes nor of a specific treatment modality. The advantage in terms of OS and CSS in patients undergoing preoperative URS could derive from a better selection of candidates for curative treatment. The treatment strategy is likely more influenced by tumor features than by URS findings.