Pub Date : 2023-07-31DOI: 10.22465/juo.224400400020
Dongsu Kim, B. Lim, J. Suh, D. You, Cheryn Song, I. Jeong, B. Hong, J. Hong, H. Ahn
Purpose: To compare the oncological outcomes between patients with pathologic T3a (pT3a) renal cell carcinoma (RCC) who underwent partial nephrectomy (PN) and radical nephrectomy (RN).Materials and Methods: We retrospectively reviewed 149 patients with pT3a N0 M0 RCC who underwent PN and RN between 2001 and 2012. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed using the Kaplan-Meier method and prognostic factors were identified using Cox proportional hazard regression models.Results: A total of 41 recurrences (27.5%) and 24 cancer related death (16.1%) were observed during a median follow-up of 136 months (interquartile range, 77–163 months). We observed no significant differences in the RFS and CSS between the PN and RN (RFS: 85.4±64.0 months vs. 75.9±52.8 months, p=0.061; CSS: 153.2±52.5 months vs. 124.9±59.8 months, p=0.292). The surgical method did not affect the tumor recurrence and patients’ survival. On multivariable Cox regression analysis, only tumor size remained associated with worse RFS (hazard ratio [HR], 1.237; 95% confidence interval [CI], 1.132–1.350; p<0.001) and CSS (HR, 1.156; 95% CI, 1.027–1.302; p=0.017).Conclusions: Due to the large tumor size, there may be hesitation in performing PN concerning pT3a in postoperative biopsy. Our study findings suggest that since tumor size is the only prognostic factor, PN can be performed in pT3a as long as there is no thrombus in the renal vein.
{"title":"Efficacy of Partial Nephrectomy in the Management of Unpredicted pT3a Renal Cell Carcinoma","authors":"Dongsu Kim, B. Lim, J. Suh, D. You, Cheryn Song, I. Jeong, B. Hong, J. Hong, H. Ahn","doi":"10.22465/juo.224400400020","DOIUrl":"https://doi.org/10.22465/juo.224400400020","url":null,"abstract":"Purpose: To compare the oncological outcomes between patients with pathologic T3a (pT3a) renal cell carcinoma (RCC) who underwent partial nephrectomy (PN) and radical nephrectomy (RN).Materials and Methods: We retrospectively reviewed 149 patients with pT3a N0 M0 RCC who underwent PN and RN between 2001 and 2012. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed using the Kaplan-Meier method and prognostic factors were identified using Cox proportional hazard regression models.Results: A total of 41 recurrences (27.5%) and 24 cancer related death (16.1%) were observed during a median follow-up of 136 months (interquartile range, 77–163 months). We observed no significant differences in the RFS and CSS between the PN and RN (RFS: 85.4±64.0 months vs. 75.9±52.8 months, p=0.061; CSS: 153.2±52.5 months vs. 124.9±59.8 months, p=0.292). The surgical method did not affect the tumor recurrence and patients’ survival. On multivariable Cox regression analysis, only tumor size remained associated with worse RFS (hazard ratio [HR], 1.237; 95% confidence interval [CI], 1.132–1.350; p<0.001) and CSS (HR, 1.156; 95% CI, 1.027–1.302; p=0.017).Conclusions: Due to the large tumor size, there may be hesitation in performing PN concerning pT3a in postoperative biopsy. Our study findings suggest that since tumor size is the only prognostic factor, PN can be performed in pT3a as long as there is no thrombus in the renal vein.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"118 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122625588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.22465/juo.234600280014
Y. Jo, Jun Seok Kim, Yoo Sub Shin, Jongchan Kim, W. S. Jang, J. Park, W. Ham
Purpose: Although radical cystectomy (RC) and concurrent chemoradiotherapy (CCRT) are curative options for muscle-invasive bladder cancer (MIBC), the optimal treatment strategy for MIBC patients with a history of nephroureterectomy for upper tract urothelial carcinoma (UTUC) remains unclear. This retrospective analysis was conducted to compare survival rates and evaluate prognostic factors related to treatment outcomes.Materials and Methods: We conducted a multi-institutional retrospective study of patients with MIBC after nephroureterectomy for UTUC between 2005 to 2023. Out of 75 patients, 30 underwent bladder-preserving therapy (BPT), including 22 patients who underwent radiation therapy (RT) and 8 patients who underwent CCRT, while 45 patients underwent RC. The overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) after BPT and RC were evaluated using Kaplan-Meier curves. Cox regression analysis was used to identify variables associated with OS, CSS, and PFS. Posttreatment changes in renal function were compared.Results: At 3 years, the OS, CSS, and PFS rates in the BPT group were 52.4%, 71.7%, and 31.3%, respectively, with no significant difference compared to RC. In multivariate analysis, bladder cancer T stage was the only predictive factor for OS, CSS, and PFS. Similar results were also observed in the RT group compared to RC. A significant decrease in renal function was detected among patients in the RC group, while patients in the BPT group maintained preserved renal function. Patients in the BPT group experienced a lower grade of toxicity after treatment compared to those in the RC group, and the rates of survival with functional bladder at 1 year, 3 years, and 5 years were 87.0%, 69.9%, and 69.9%, respectively.Conclusions: Bladder-preserving therapy, including RT alone, may be a viable treatment option for patients with MIBC who have undergone nephroureterectomy, as it can achieve comparable oncologic outcomes to RC, while potentially preserving bladder and renal function.
{"title":"Radical Cystectomy Versus Bladder-Preserving Therapy in Muscle-Invasive Bladder Cancer Patients After Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Multicenter Retrospective Analysis","authors":"Y. Jo, Jun Seok Kim, Yoo Sub Shin, Jongchan Kim, W. S. Jang, J. Park, W. Ham","doi":"10.22465/juo.234600280014","DOIUrl":"https://doi.org/10.22465/juo.234600280014","url":null,"abstract":"Purpose: Although radical cystectomy (RC) and concurrent chemoradiotherapy (CCRT) are curative options for muscle-invasive bladder cancer (MIBC), the optimal treatment strategy for MIBC patients with a history of nephroureterectomy for upper tract urothelial carcinoma (UTUC) remains unclear. This retrospective analysis was conducted to compare survival rates and evaluate prognostic factors related to treatment outcomes.Materials and Methods: We conducted a multi-institutional retrospective study of patients with MIBC after nephroureterectomy for UTUC between 2005 to 2023. Out of 75 patients, 30 underwent bladder-preserving therapy (BPT), including 22 patients who underwent radiation therapy (RT) and 8 patients who underwent CCRT, while 45 patients underwent RC. The overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) after BPT and RC were evaluated using Kaplan-Meier curves. Cox regression analysis was used to identify variables associated with OS, CSS, and PFS. Posttreatment changes in renal function were compared.Results: At 3 years, the OS, CSS, and PFS rates in the BPT group were 52.4%, 71.7%, and 31.3%, respectively, with no significant difference compared to RC. In multivariate analysis, bladder cancer T stage was the only predictive factor for OS, CSS, and PFS. Similar results were also observed in the RT group compared to RC. A significant decrease in renal function was detected among patients in the RC group, while patients in the BPT group maintained preserved renal function. Patients in the BPT group experienced a lower grade of toxicity after treatment compared to those in the RC group, and the rates of survival with functional bladder at 1 year, 3 years, and 5 years were 87.0%, 69.9%, and 69.9%, respectively.Conclusions: Bladder-preserving therapy, including RT alone, may be a viable treatment option for patients with MIBC who have undergone nephroureterectomy, as it can achieve comparable oncologic outcomes to RC, while potentially preserving bladder and renal function.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123085915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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