The Consequences of Inadvertent Radical Nephrectomy in the Treatment of Upper Tract Urothelial Carcinoma - 11/08/21
, Jonathan E Shoag 1, 2, Spyridon P. Basourakos 1, Patrick J. Lewicki 1, Lina Posada 1, Xiaoyue Ma 3, Jay D. Raman 4, Shahrokh F. Shariat 1, 5, 6, 7, 8, Douglas Scherr 1Abstract |
Objective |
To determine factors associated with performing inadvertent radical nephrectomy (RN) for upper tract urothelial carcinoma (UTUC), and to assess the impact of radical nephrectomy on overall survival (OS) compared to radical nephroureterectomy (NU).
Methods |
Using the National Cancer Database (NCDB), patients with UTUC of the renal pelvis who were diagnosed with renal cortical tumors and underwent RN (n = 820) with subsequent surgical pathology demonstrating urothelial carcinoma were identified. These patients were compared to those diagnosed with renal pelvis tumors who appropriately underwent NU (n = 16,464) between 2005 and 2015. Multivariable logistic regression was used to determine patient, facility and tumor-related factors associated with undergoing RN. The impact of surgery (RN vs NU) on OS was determined by Cox-regression after propensity score matching.
Results |
A total of 4.7% patients with UTUC underwent inadvertent RN. Black race (adjusted odds ratio [aOR] 1.62, 95%CI 1.23-2.13), larger tumors, advanced tumor stage, and high-grade tumors (P < 0.0001) were associated with RN. However, surgery at a facility performing a higher volume of NU/year was associated with lower odds of having RN performed (aOR 0.85, 95%CI 0.75-0.97). After propensity score matching, the 5-year OS was 39.9% for those undergoing RN vs 49.9% for those undergoing NU (hazard ratio 1.45, 95%CI 1.30-1.62).
Conclusion |
Inadvertent RN is not uncommon, occurring in almost 5% of patients with UTUC in the NCDB. Patients who underwent RN had significantly worse OS as compared to those treated with NU. These data highlight that accurate diagnosis of UTUC is paramount and clinicians should not hesitate to perform further workup when imaging findings are equivocal.
Le texte complet de cet article est disponible en PDF.Keywords : Radical nephrectomy, Radical nephroureterectomy, Upper tract urothelial carcinoma
Plan
| Conflict Of Interest: No conflict. |
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| Funding Support: JS and DS are supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. JS is supported by Damon Runyon Cancer Research Foundation physician scientist training award. XM is partially reported by the following grant: Clinical and Translational Science Center at Weill Cornell Medicine (1-UL1-TR002384-01). |
Vol 154
P. 127-135 - août 2021 Retour au numéro
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