Oncological and renal function outcomes in patients who underwent simultaneous radical cystectomy and nephroureterectomy for synchronous or metachronous panurothelial carcinoma
José Daniel Subiela 1 , Daniel A González-Padilla 2 , Jorge Huguet 3 , Júlia Aumatell 3 , Oscar Rodríguez-Faba 3 , Wojciech Krajewski 4 , Alejandro Hevia Feliu 5 , Cesar Mínguez 6 , José López Plaza 6 , Alberto Artiles Medina 6 , Pablo Gajate 7 , Miguel Ángel Jiménez Cidre 6 , Javier Burgos Revilla 6 , Alberto Breda 2 , Joan Palou 2
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.