Bladder cuff excision at radical nephroureterectomy improved survival in upper tract urothelial carcinoma

Abstract

Objective

To test for survival differences after radical nephroureterectomy (RNU) in pT1-T3N0 upper tract urothelial carcinoma (UTUC) patients according to bladder cuff excision (BCE) status.

Methods

Within the Surveillance, Epidemiology, and End Results database (2004–2020), we identified RNU patients and documented BCE status. Prior and after propensity score matching (ratio 1:1), cumulative incidence plots and competing risk regression (CRR) models addressed cancer specific mortality (CSM) and other-cause mortality (OCM).

Results

Of 4,426 RNU-treated patients, 3,186 (72%) patients underwent BCE and 1,240 (28%) did not. BCE rates significantly increased over time from 65.2 to 77.0% (EAPC: +1.0%, 95% CI +0.4 to +1.6%, P = 0.004) between 2004 and 2020. After 1:1 propensity score matching for T stage, 1,240 of 1,240 (100%) RNU patients without BCE and 1,240 of 3,186 (39%) RNU patients with BCE were included in subsequent analyses. Five-year CSM rates were 30% in RNU with BCE vs. 36% in RNU without BCE patients (Δ = 6%). In multivariable CRR, RNU with BCE independently predicted lower CSM (HR: 0.81, 95% CI: 0.70–0.93; P < 0.001). Conversely, BCE status did not affect OCM (P = 0.4).

Conclusion

The rate of guideline recommended BCE at RNU increased over time. Additionally, RNU with BCE is associated with significantly lower CSM than RNU without BCE in pT1-T3N0 UTUC patients. In consequence, BCE should represent an integral part of a comprehensive RNU.