Roberta Corvino, Giuseppe Basile, Valerio Santarelli, Vincenzo Asero, Ettore De Berardinis, Alessandro Sciarra, Luigi Vittori, Yasmin Abu-Ghanem, Rajesh Nair, Muhammad Shamim Khan, Ramesh Thurairaja, Ravi Barod, Wojciech Krajewski, Jan Laszkiewicz, Simone Albisinni, Keiichiro Mori, Felix Guerrero-Ramos, David D'Andrea, Andrea Gallioli, Ekaterina Laukhtina, Agata Suleja, Elisabeth Grobet-Jeandin, Andrea Mari, Laura S Mertens, Marco Moschini, Mario De Angelis, Pietro Scillipoti, Francesco Soria, Alessandro Bosio, Jeremy Teoh, Francesco Claps, Antonio Amodeo, Aleksander Ślusarczyk, Roberto Contieri, Daniel Subiela, Ana Tagalos, Karl H Tully, Renate Pichler, Alessandro Antonelli, Riccardo Bertolo, Alessandro Veccia, Sarah Malandra, Rodolfo Hurle, Francesco Sormani, Felice Crocetto, Roman Mayr, Angelo Porreca, Giuseppe Simone, Gabriele Tuderti, Bernardo Rocco, Alchiede Simonato, Franco Alchiede Simonato, Gautier Marcq, Paolo Gontero, Zhe Tian, Pierre Karakiewicz, Benjamin I Chung, Benjamin Pradere, Francesco Del Giudice
BACKGROUND AND OBJECTIVE: Patients undergoing radical cystectomy (RC) for bladder cancer may present with synchronous or metachronous upper tract urothelial carcinoma (UTUC). These scenarios may differ in oncological outcomes and surgical complexity. This study sought to compare oncologic and perioperative outcomes in patients undergoing RC and radical nephroureterectomy (RNU) for synchronous or metachronous UTUC.
METHODS: Data from 23 tertiary referral centers were retrospectively collected (2002-2024). Perioperative outcomes included length of stay (LOS) and complications (Clavien-Dindo classification). Disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS) were estimated from RC using Kaplan-Meier and landmark analysis. Multivariable Cox regression modeling identified predictors of DFS and OS and explored the impact of RNU timing on oncological outcomes.
KEY FINDINGS AND LIMITATIONS: Among 177 RC patients (n = 142 [80%] males), 106 (60%) underwent RNU subsequent to RC for metachronous UTUC. Concomitant RC and RNU led to longer LOS (10 vs. 7 days, P = 0.004), and statistically significant higher rate of major complications (Clavien-Dindo ≥ IIIa, 29.6% vs. 15.1%, P = 0.03). Metachronous disease showed better 60-month DFS (69.1% vs. 47.6%), CSS (80.3% vs. 66.4%) and OS (69.2% vs. 47.6%). Histological subtype at RNU independently predicted worse DFS (HR 2.64, P = 0.01) and OS (HR 3.22, P = 0.01), while metachronous presentation predicted better DFS (HR 0.36, P < 0.001) and OS (HR 0.53, P = 0.04). Limitations include the retrospective design and a relatively limited sample size.
CONCLUSIONS AND CLINICAL IMPLICATIONS: Synchronous panurothelial disease at diagnosis requiring RC and RNU is related to worse perioperative and survival outcomes compared to metachronous disease. Our results highlight the need for dedicated studies to define individualized treatment and surveillance strategies for this challenging patient population.