Oncological and renal function outcomes in patients who underwent simultaneous radical cystectomy and nephroureterectomy for synchronous or metachronous panurothelial carcinoma

Objective: To assess clinical outcomes of patients who underwent simultaneous radical cystectomy (RC) and radical nephroureterectomy (RNU) for panurothelial carcinoma (PanUC).

Materials and methods: A retrospective analysis of 67 patients who underwent simultaneous RC and unilateral RNU for PanUC, from 1996 to 2017. Kaplan-Meier estimates for remnant urothelium recurrence-free survival (RRFS), metastasis-free survival (MFS), overall survival (OS), and cancer-specific survival (CSS) were performed. Cox multivariate models were constructed.

Results: The median follow-up was 38 months, 29.8% of patients had a recurrence, 34.3% had metastasis, 67.2% of patients died from any cause, and 37.3% died from urothelial carcinoma. OS and CSS rates at 5 years were 44% and 61%, respectively. In multivariate analysis, progression to muscle-invasive bladder cancer before surgery, presence of muscle-invasive stages at RC and/or RNU, and prostatic urethra involvement were predictors for worse MFS and CSS. Forty-one patients (61.2%) had an estimated glomerular filtration rate (eGFR) <60 ml/min before surgery and the number rose to 56 (83.5%) after surgery; 29.8% patients needed renal function replacement therapy after surgery (16 haemodialysis and 4 renal transplant).

Conclusion: Patients with PanUC who undergo simultaneous surgery have adverse oncological (only 4 out of every 10 remain alive at 5 years) and functional outcomes (1 out of 3 will need renal function replacement therapy after surgery). Up to a third of the patients had a recurrence (urethra or contralateral kidney) within 18 months, justifying close surveillance or considering prophylactic urethrectomy. These data should help in counsel on morbidity and life expectancy.

CITA DEL ARTÍCULO  Urology. 2023 Feb;172:157-164.  doi: 10.1016/j.urology.2022.08.064.  Epub 2022 Nov 25.