Cytoreductive nephroureterectomy for treatment of upper urinary tract urothelial carcinoma initially diagnosed as node-positive

Urothelial carcinomas of the upper urinary tract (UTUC) are rare tumors with a high malignancy degree. Radical nephroureterectomy (RNU) with bladder cuff excision remains one of the standard treatments in clinically localized or locally advanced UTUCs. However, the role of cytoreductive RNU in treating clinically lymph node-positive (N+) UTUCs remains unclear. A nationwide retrospective study was conducted by the Taiwan UTUC Collaboration Group from July 1988 to June 2022. Patients with clinical N + UTUC before initiation of cancer therapy were included in this study. Initial clinically node-positive disease was noted in 288 (5.4%) of the 5,301 patients. Of the patients, 239 (83%) patients underwent RNU. UTUC-related mortality was markedly higher among patients not receiving RNU than among those who underwent surgery (69.4% vs. 36%). After adjusting for the effects of stepwise enrolled parameters, multivariate analysis showed that undergoing RNU (or not) and smoking (or not) were the only independent predictors of overall survival (OS). After adjusting for the effects of significant stepwise enrolled variables, multivariate analysis showed that RNU and smoking (or not) were the only independent predictors of cancer-specific survival (CSS). Our findings showed that RNU is associated with better OS and CSS in Taiwanese patients with N + UTUC. Common patient characteristics and most cancer characteristics were not related to the outcome. Our results provide new evidence on the efficacy of RNU for patients with N + UTUC, which could alter and guide the direction of future treatment guidelines.

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Publication Details

Journal
Scientific Reports
Published
2025-08-12
DOI
https://doi.org/10.1038/s41598-025-14947-4
Primary Topic
Bladder and Urothelial Cancer Treatments
Type
article
Field-Weighted Citation Impact
0.00

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article

Cytoreductive nephroureterectomy for treatment of upper urinary tract urothelial carcinoma initially diagnosed as node-positive

Chi‐Ping Huang, Yu‐Khun Lee, Wen‐Hsin Tseng, Hung-Keng Li et al.
Scientific Reports
Bladder and Urothelial Cancer Treatments
article

Cytoreductive nephroureterectomy for treatment of upper urinary tract urothelial carcinoma initially diagnosed as node-positive

Chi‐Ping Huang, Yu‐Khun Lee, Wen‐Hsin Tseng, Hung-Keng Li, Yung‐Tai Chen, Jian‐Ri Li, Wun‐Rong Lin, Ting-En Tai, Chao‐Yuan Huang, Han‐Yu Weng, Wei-Chieh Chen, Steven K. Huang, Yao‐Chou Tsai, Pi-Che Chen, Hung‐Lung Ke, Shian‐Shiang Wang, Jen‐Shu Tseng, Hsu-Che Huang, Wei‐Ming Li, Po‐Hung Lin, Jen‐Tai Lin, I‐Hsuan Chen, Shu‐Yu Wu, Chao‐Hsiang Chang, Chia‐Chang Wu, Chi-Wen Lo, Yuan‐Hong Jiang, Wei-Yu Lin, Thomas Y. Hsueh
article en

Abstract

Urothelial carcinomas of the upper urinary tract (UTUC) are rare tumors with a high malignancy degree. Radical nephroureterectomy (RNU) with bladder cuff excision remains one of the standard treatments in clinically localized or locally advanced UTUCs. However, the role of cytoreductive RNU in treating clinically lymph node-positive (N+) UTUCs remains unclear. A nationwide retrospective study was conducted by the Taiwan UTUC Collaboration Group from July 1988 to June 2022. Patients with clinical N + UTUC before initiation of cancer therapy were included in this study. Initial clinically node-positive disease was noted in 288 (5.4%) of the 5,301 patients. Of the patients, 239 (83%) patients underwent RNU. UTUC-related mortality was markedly higher among patients not receiving RNU than among those who underwent surgery (69.4% vs. 36%). After adjusting for the effects of stepwise enrolled parameters, multivariate analysis showed that undergoing RNU (or not) and smoking (or not) were the only independent predictors of overall survival (OS). After adjusting for the effects of significant stepwise enrolled variables, multivariate analysis showed that RNU and smoking (or not) were the only independent predictors of cancer-specific survival (CSS). Our findings showed that RNU is associated with better OS and CSS in Taiwanese patients with N + UTUC. Common patient characteristics and most cancer characteristics were not related to the outcome. Our results provide new evidence on the efficacy of RNU for patients with N + UTUC, which could alter and guide the direction of future treatment guidelines.

Scientific ReportsVol. 15(1)
National Taiwan Normal University (TW), Chang Gung University of Science and Technology (TW), National Sun Yat-sen University (TW), National Yang Ming Chiao Tung University (TW), Kaohsiung Medical University (TW), Chang Gung University (TW), China Medical University (TW), Tzu Chi University (TW), National Chi Nan University (TW), Tzu Chi Foundation (TW), Taipei Medical University Hospital (TW), Kaohsiung Medical University Chung-Ho Memorial Hospital (TW), Mackay Memorial Hospital (TW), Mackay Medical University (TW), Taichung Veterans General Hospital (TW), Taipei Tzu Chi Hospital (TW), Far Eastern Memorial Hospital (TW), Chia-Yi Christian Hospital (TW), Linkou Chang Gung Memorial Hospital (TW), Taiwan Adventist Hospital (TW), Taipei City Hospital (TW), Ministry of Health and Welfare (TW), China Medical University Hospital (TW), Taipei Hospital (TW), National Taiwan University Hospital (TW), Chi Mei Medical Center (TW), Pingtung Hospital (TW), Kaohsiung Veterans General Hospital (TW), Cardinal Tien Hospital (TW), Chiayi Chang Gung Memorial Hospital (TW), Taipei Medical University-Shuang Ho Hospital (TW), National Cheng Kung University Hospital (TW), Taipei Medical University (TW), Chang Jung Christian University (TW), Chung Shan Medical University (TW), National Yang Ming Chiao Tung University (TW)
Buddhist Tzu Chi Medical Foundation
Good health and well-being
Openalex Percentile: Top 67%
Bladder and Urothelial Cancer Treatments
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