PD58-09: Is Segmental Ureterectomy Associated with Inferior Survival for Localized Upper Tract Urothelial Carcinoma of the Ureter Compared to Radical Nephroureterectomy

Marco Paciotti*, Rozzano, Italy, Khalid Alkhatib, David-Dan Nguyen, Kendrick Yim, Stuart R. Lipsitz, Matthew Mossanen, Adam S. Kibel, Quoc-Dien Trinh, Boston, MA, Nicoló Buffi, Giovanni Lughezzani, Rozzano, Italy, Alexander P. Cole, Boston, MA

Introduction: Segmental ureterectomy (SU) is a less intensive alternative to radical nephroureterectomy (RNU) in treatment of upper tract urothelial carcinoma (UTUC) of the ureter. SU generally preserves renal function, at the expense of less intensive cancer control. Our objective is to assess whether SU is associated with inferior survival compared to RNU.

Methods: Using the National Cancer Database (NCDB), we identified patients diagnosed with localized UTUC of the ureter between 2004-2015. We used a propensity-score-overlap-weighted (PSOW) multivariable survival model to compare survival following SU vs. RNU. PSOW- adjusted Kaplan-Meier curves were generated and we performed a non-inferiority test of overall survival with an a priori upper-bound for inferiority set at hazard ratio (HR) of 1.1 with a one-sided alpha of 0.05.

Results: A population of 13,061 individuals with UTUC of the ureter receiving either SU or RNU were identified. Of these, 9,016 underwent RNU and 4,045 SU. Factors associated with decreased likelihood of receiving SU were female gender (OR, 0.81; 95% CI, 0.75 - 0.88; P < 0.001), advanced clinical T stage (cT4: OR, 0.51; 95% CI, 0.30 - 0.88; P = 0.015), and high-grade tumor (OR, 0.76; 95% CI, 0.67 - 0.86; P < 0.001). Age greater than 79 years was associated with increased probability of undergoing SU (OR, 1.18; 95% CI, 1.00 - 1.38; P = 0.047). There was no statistically significant difference in OS between SU and RNU (HR, 0.98; 95% CI, 0.93 – 1.04; P = 0.538). SU was not inferior to RNU in PSOW-adjusted Cox regression analysis (P <0.001 for non-inferiority). Retrospective design is the main limitation of the stud

Conclusions: In weighted cohorts of individuals with UTUC of the ureter, the use of SU was not associated with inferior survival compared to RNU. Urologists should continue to utilize SU in appropriately selected patients.

Source of Funding: None