While radical nephroureterectomy (RNU) is the gold standard for patients with upper tract urothelial carcinoma (UTUC), segmental ureterectomy (SU) may be an option for some patients, according to new study results published in Clinical Genitourinary Cancer.

Riccardo Autorino, MD, PhD, of VCU Health Richmond in Virginia, and his colleagues conducted a systematic review and meta-analysis of 18 nonrandomized studies of intermediate quality published from 2000 to 2019 comparing the 2 procedures. The meta-analysis included a total of 1313 SU and 3484 RNU patients with similar baseline characteristics.

SU patients were twice as likely to have a history of bladder cancer as RNU patients. They also had a 7.5-fold greater likelihood of ureteral tumors. Bladder tumor seeding near ureteral orifices could explain this finding, according to the investigators. The SU group was also half as likely to present with preoperative hydronephrosis. Previous research links hydronephrosis to more advanced disease. In addition, SU patients were 34% less likely to have a cancer stage of pT2 or higher and 38% less likely to have high-grade tumors than RNU patients. All of the aforementioned differences between the SU and RNU groups were statistically significant.

After surgery, estimated glomular filtration rate (eGFR) rose a mean 10.97 mL/min/1.73 m2 higher in the SU group. SU patients, however, had significant 36% decreased odds of 5-year relapse-free survival compared with RNU patients.

Ureteral tumor location, especially distal location, and history of bladder cancer, have been associated with shorter relapse-free survival, the investigators noted. There were no statistically significant differences between groups in positive surgical margin rates. Overall, 16% of SU patients and 15% of RNU patients received adjuvant chemotherapy. Metastasis-free and cancer-specific survival at 5 years did not differ between groups.

“SU can be considered as a treatment option for patients with UTUC in selected cases as it offers better preservation of renal function,” Dr Autorino’s team concluded. “However, a strict follow-up is mandatory in these cases to avoid jeopardizing the oncologic outcome. In advanced high-risk disease, RNU remains the standard of care.”

The researchers could not distinguish standard distal SU (bladder cuff and ureteroneocystostomy) from true SU (portion of ureter excision with uretero-ureterostomy), which was a study limitation.

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Reference

Veccia A, Antonelli A, Checcucci E, et al. Segmental ureterectomy for upper tract urothelial carcinoma: A systematic review and meta-analysis of comparative studies. Clin Genitourin Canc. doi:10.1016/j.clgc.2019.10.015