Perioperative Complications and In-Hospital Mortality in Radical Nephroureterectomy Patients with Heart Valve Replacement

Endoscopic ablation versus nephroureterectomy in localized low-grade upper tract urothelial carcinoma: a comparison in terms of cancer-specific and other-cause mortality

PURPOSE

Guidelines recommend endoscopic ablation in select upper urinary tract urothelial carcinoma (UTUC) patients. To test for differences in cancer-specific mortality (CSM) and other-cause mortality (OCM) in localized non-invasive low-grade UTUC with tumor size < 2 cm treated with endoscopic ablation vs. radical nephroureterectomy.

METHODS

Within Surveillance, Epidemiology, and End Results database (2000-2020), we identified UTUC patients treated with either endoscopic ablation or radical nephroureterectomy. After propensity score matching (ratio 1:1), cumulative incidence plots, and competing risks regression models addressed CSM and OCM.

RESULTS

Of 249 included UTUC patients, 66 (27%) were treated with endoscopic ablation vs. 183 (73%) with radical nephroureterectomy. Over the study period, endoscopic ablation use increased from 10 to 45% (p = 0.01). After 1:1 propensity score matching, 66 of 66 (100%) endoscopic ablation and 66 of 183 (36%) radical nephroureterectomy patients were included. Ten-year CSM rates were 15.7% after endoscopic ablation vs. 13.9% after radical nephroureterectomy (p = 0.9). Ten-year OCM rates were 46.3% after endoscopic ablation vs. 57.9% after radical nephroureterectomy (p = 0.5). In multivariable competing risks regression models, CSM (hazard ratio 1.10; p = 0.9) and OCM (hazard ratio 0.83; p = 0.5) did not differ according to use of endoscopic ablation vs. radical nephroureterectomy.

CONCLUSION

Endoscopic ablation of localized non-invasive low-grade UTUC with tumor size < 2 cm results in absence of cancer-control outcome differences relative to radical nephroureterectomy. This observation validates the current guideline recommendations.

Non-Caucasian Race/Ethnicity Predisposes to Unfavorable Stage and Grade at Upper Tract Urothelial Carcinoma Diagnosis

OBJECTIVE

To test whether race/ethnicity affects stage or grade distribution at upper tract urothelial carcinoma (UTUC) diagnosis.

METHODS

Within the Surveillance, Epidemiology, and End Results (SEER) database 2004-2020, UTUC patients were identified. Multivariable logistic regression models tested for the association between race/ethnicity and stage as well as grade at diagnosis according to renal pelvis vs. ureteral origin. Stage at presentation was defined as (i) metastatic stage (TanyNanyM1) and (ii) advanced stage (locoregional or metastatic (T3-4N0-2M0-1)).

RESULTS

Of 14,384 UTUC patients, 8926 (62%) were renal pelvis. Of renal pelvis UTUC patients, 7064 (79%) were Caucasian, 797 (9%) Hispanic, 623 (7%) Asian Pacific Islander (API), and 442 (5%) African American (AA). Relative to Caucasians, API (odd ratio (OR) 1.85, 95% confidence interval (CI) 1.44-2.37, p < 0.001) and AA (OR 1.37, 95% CI 1.02-1.83, p = 0.03) patients more frequently harbored metastatic stage. APIs also more frequently harbored advanced (OR 1.33, 95% CI 1.11-1.60, p = 0.002) stage and high (OR 1.33, 95% CI 1.07-1.67, p = 0.01) grade. Of 5458 (38%) ureteral UTUC patients, 4360 (80%) were Caucasian, 362 (7%) Hispanic, 509 (9%) API, and 227 (4%) AA. Relative to Caucasians, Hispanic (OR 1.45, 95% CI 1.01-2.05, p = 0.03) patients more frequently harbored metastatic stage. APIs also more frequently harbored advanced stage (OR 1.22, 95% CI 1.02-1.47, p = 0.03) and high (OR 1.94, 95% CI 1.49-2.55, p < 0.001) grade.

CONCLUSIONS

Race/ethnicity other than Caucasian, such as API and Hispanic, may predispose to higher odds of metastatic (TanyNanyM1) or advanced (T3-4N0-2M0-1) stages as well as to higher grade at initial diagnosis.