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Rigshospitalet - en del af Københavns Universitetshospital
Udgivet

Oncological outcomes of radical nephroureterectomy for upper urinary tract urothelial neoplasia in Denmark

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  • Nessn H Azawi
  • Sara Haunstrup Næraa
  • Yousif Subhi
  • Juan Luis Vásquez
  • Thomas Norus
  • Claus Dahl
  • Peter Thind
  • Jørgen Bjerggaard Jensen
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Objective: To report the oncological outcomes of radical nephroureterectomy for upper urinary tract urothelial neoplasia in a large study sample.Materials and methods: This was a nationwide multicenter registry-based cohort study of all patients with upper urinary tract urothelial neoplasia in Denmark found to be eligible for nephroureterectomy between April 2004 and April 2017 (N = 1384). Primary endpoints were intravesical recurrence-free survival and overall survival. Survival probabilities were estimated with Kaplan-Meier and the log-rank test to compare survival curves. Association with clinical outcomes was studied using univariate and multivariate Cox proportional hazards.Results: Intravesical recurrence-free survival was 72% [95% confidence interval (CI) 69-75%] at 5 years and 70% (95% CI 67-73%) at 10 years. Patients with muscle-invasive disease had a significantly lower rate of intravesical recurrence [hazard ratio (HR) = 0.46, p < 0.0001] and patients with high-grade tumors had a significantly higher rate of incident intravesical recurrence compared to low-grade tumors (HR = 1.65, p = 0.001). The overall survival was 76% (95% CI 74-79%) at 5 years and 64% (95% CI 60-70%) at 10 years. Patients with higher age (p = 0.008) and muscle-invasive disease (p < 0.0001) had worse overall survival. When comparing surgical approaches, laparoscopic nephroureterectomy versus open nephroureterectomy did not differ in intravesical recurrence-free survival but was associated with shorter postoperative hospital stay (p < 0.0001) and better overall survival (p = 0.02).Conclusions: We report the oncological outcomes of radical nephroureterectomy for upper urinary tract urothelial neoplasia in a large sample and give insights into predictive factors with significant impact.

OriginalsprogEngelsk
TidsskriftScandinavian Journal of Urology
Vol/bind54
Udgave nummer1
Sider (fra-til)58-64
Antal sider7
ISSN2168-1805
DOI
StatusUdgivet - feb. 2020

ID: 60879894