The Impact of II-look Ureteroscopy on Survival in Upper Tract Urothelial Carcinoma: A Multicenter Retrospective Study of EAU-YAU Urothelial Working Group
Por:
Gallioli, A, Di Bello, F, Laukhtina, E, D'Andrea, D, Beltrami, P, Celso, FG, Krajewski, W, Afferi, L, Soria, F, Marcq, G, Del Giudice, F, De Lorenzis, E, Moschini, M, Mari, A, Subiela, JD, Baboudjian, M, Avesani, G, Territo, A, Basile, G, Dieguez, L, Izquierdo, P, Palou, J, Pradere, B, Breda, A
Publicada:
1 jun 2026
Ahead of Print:
1 abr 2026
Resumen:
Background and objective: No previous study quantified the survival outcomes of second-look ureteroscopy (SU). We hypothesized that patients who underwent SU might exhibit better survival outcomes than their no-SU counterparts. Methods: We relied on a multicenter retrospective database including 358 patients with UTUC treated conservatively between 2010 and 2021. Endpoints, namely overall survival (OS) and radical nephroureterectomy (RNU) rates, modeled as competing event for other-cause mortality (OCM), were quantified. Cancer-specific mortality (CSM), and OCM were also quantified according to SU. Inverse probability of treatment weighting (IPTW) methodology was used to assess OS. Landmark analysis for OS at 2 mo was also performed. Key findings: Based on a median follow-up of 32 mo (interquartile range 16-56), 291 patients with UTUC were identified. Of those, 148 (51%) underwent SU. Median OS in patients who underwent SU was 103 versus 66 mo in patients without SU (D = 37 mo; p = 0.0024). RNU rates did not differ among the groups (24 vs 21%, p = 0.8). In IPTW-adjusted multivariable Cox regression models, adjusted number of lesions, tumor size, age, UTUC site, Charlson Comorbidity Index, high-grade, cytology, and ureteroscopy indication, SU patients were associated with higher OS rates compared to those without SU (hazard ratio 0.59, 95% confidence interval 0.37-0.94; p = 0.02). Within tumor <= 10 mm, four (3%) UTUC recurred in the first 9 mo of follow-up. Conclusions and clinical implications: Within the current study, SU ensured an optimal clinical decision-making. Specifically, CSM and OCM rates of SU patients and their counterparts not receiving SU validated the patients with UTUC selection for conservative treatment. (c) 2026 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creative-commons.org/licenses/by-nc-nd/4.0/).
Filiaciones:
Gallioli, A:
Fundacio Puigvert, Urol, Barcelona, Spain
Autonomous Univ Barcelona, Dept Surg, Barcelona, Spain
Inst Recerca St Pau IR St Pau, Barcelona, Spain
Di Bello, F:
Fundacio Puigvert, Urol, Barcelona, Spain
Univ Naples Federico II, Dept Neurosci Sci Reprod & Odontostomatol, Via Pansini, I-80131 Naples, Italy
Laukhtina, E:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
D'Andrea, D:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Beltrami, P:
Univ Padua, Dept Surg Oncol & Gastroenterol, Urol Clin, Padua, Italy
Celso, FG:
Univ Padua, Dept Surg Oncol & Gastroenterol, Urol Clin, Padua, Italy
Krajewski, W:
Wroclaw Med Univ, Minimally Invas & Robot Urol, Wroclaw, Poland
Afferi, L:
Luzerner Kantonsspital, Urol, Luzern, Switzerland
Kantonsspital Aarau, Dept Urol, Aarau, Switzerland
Soria, F:
Univ Turin, Turin, Italy
Citta Salute & Sci, Surg Sci, Turin, Italy
Marcq, G:
Claude Huriez Hosp, Urol, Lille, France
Del Giudice, F:
Sapienza Univ Rome, Policlin Umberto I Hosp, Dept Maternal Infant & Urol Sci, Rome, Italy
De Lorenzis, E:
Univ Milan, Dept Clin Sci & Community Hlth, Milan, Italy
Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Urol, Milan, Italy
Moschini, M:
IRCCS San Raffaele Hosp, Urol, Milan, Italy
Mari, A:
Univ Florence, Florence, Italy
Careggi Hosp, Urol Robot Surg & Renal Transplantat, Florence, Italy
Subiela, JD:
Univ Alcala, Hosp Univ Ramon y Cajal IRYCIS, Urol, Madrid, Spain
Baboudjian, M:
North Acad Hosp, AP HM, Dept Urol, Marseille, France
Avesani, G:
Fundacio Puigvert, Urol, Barcelona, Spain
IRCCS San Raffaele Hosp, Urol, Milan, Italy
Territo, A:
Fundacio Puigvert, Urol, Barcelona, Spain
Basile, G:
Fundacio Puigvert, Urol, Barcelona, Spain
Dieguez, L:
Fundacio Puigvert, Urol, Barcelona, Spain
Izquierdo, P:
Fundacio Puigvert, Urol, Barcelona, Spain
Palou, J:
Fundacio Puigvert, Urol, Barcelona, Spain
Pradere, B:
Urosud Croix Sud Hosp, Urol, Quint Fonsegrives, France
Breda, A:
Fundacio Puigvert, Urol, Barcelona, Spain
Green Submitted, gold
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