Urethrectomy at the time of radical cystectomy for non-metastatic urothelial carcinoma of the bladder: a collaborative multicenter study
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Urethrectomy at the time of radical cystectomy for non-metastatic urothelial carcinoma of the bladder: a collaborative multicenter study. / Laukhtina, Ekaterina; Boehm, Axelle; Peyronnet, Benoit; Bravi, Carlo Andrea; Batista Da Costa, Jose; Soria, Francesco; D'Andrea, David; Rajwa, Pawel; Quhal, Fahad; Yanagisawa, Takafumi; König, Frederik; Mostafaei, Hadi; Enikeev, Dmitry; Ingels, Alexandre; Verhoest, Gregory; D'Hondt, Frederiek; Mottrie, Alexandre; Joniau, Steven; Van Poppel, Hendrik; de la Taille, Alexandre; Bensalah, Karim; Bruyère, Franck; Shariat, Shahrokh F; Pradere, Benjamin.
In: WORLD J UROL, Vol. 40, No. 7, 07.2022, p. 1689-1696.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Urethrectomy at the time of radical cystectomy for non-metastatic urothelial carcinoma of the bladder: a collaborative multicenter study
AU - Laukhtina, Ekaterina
AU - Boehm, Axelle
AU - Peyronnet, Benoit
AU - Bravi, Carlo Andrea
AU - Batista Da Costa, Jose
AU - Soria, Francesco
AU - D'Andrea, David
AU - Rajwa, Pawel
AU - Quhal, Fahad
AU - Yanagisawa, Takafumi
AU - König, Frederik
AU - Mostafaei, Hadi
AU - Enikeev, Dmitry
AU - Ingels, Alexandre
AU - Verhoest, Gregory
AU - D'Hondt, Frederiek
AU - Mottrie, Alexandre
AU - Joniau, Steven
AU - Van Poppel, Hendrik
AU - de la Taille, Alexandre
AU - Bensalah, Karim
AU - Bruyère, Franck
AU - Shariat, Shahrokh F
AU - Pradere, Benjamin
N1 - © 2022. The Author(s).
PY - 2022/7
Y1 - 2022/7
N2 - INTRODUCTION: The optimal management of the urethra in patients planned for radical cystectomy (RC) remains unclear. We sought to evaluate the impact of urethrectomy on perioperative and oncological outcomes in patients treated with RC for non-metastatic urothelial carcinoma of the bladder (UCB).MATERIALS AND METHODS: We assessed the retrospective data from patients treated with RC for UCB of five European University Hospitals. Associations of urethrectomy with progression-free (PFS), cancer-free (CSS), and overall (OS) survivals were assessed in univariable and multivariable Cox regression models. We performed a subgroup analysis in patients at high risk for urethral recurrence (UR) (urethral invasion and/or bladder neck invasion and/or multifocality and/or prostatic urethra involvement).RESULTS: A total of 887 non-metastatic UCB patients were included. Among them, 146 patients underwent urethrectomy at the time of RC. Urethrectomy was performed more often in patients with urethral invasion, T3/4 tumor stage, CIS, positive frozen section analysis of the urethra, and those who received neoadjuvant chemotherapy, underwent robotic RC, and/or received an ileal conduit urinary diversion (all p < 0.001). Estimated blood loss and the postoperative complication rate were comparable between patients who received an urethrectomy and those who did not. Urethrectomy during RC was not associated with PFS (HR 0.83, p = 0.17), CSS (HR 0.93, p = 0.67), or OS (HR 1.08, p = 0.58). In the subgroup of 276 patients at high risk for UR, urethrectomy at the time of RC decreased the risk of progression (HR 0.58, p = 0.04).CONCLUSION: In our study, urethrectomy at the time of RC seems to benefit only patients at high risk for UR. Adequate risk assessment of UCB patients' history may allow for better clinical decision-making and patient counseling.
AB - INTRODUCTION: The optimal management of the urethra in patients planned for radical cystectomy (RC) remains unclear. We sought to evaluate the impact of urethrectomy on perioperative and oncological outcomes in patients treated with RC for non-metastatic urothelial carcinoma of the bladder (UCB).MATERIALS AND METHODS: We assessed the retrospective data from patients treated with RC for UCB of five European University Hospitals. Associations of urethrectomy with progression-free (PFS), cancer-free (CSS), and overall (OS) survivals were assessed in univariable and multivariable Cox regression models. We performed a subgroup analysis in patients at high risk for urethral recurrence (UR) (urethral invasion and/or bladder neck invasion and/or multifocality and/or prostatic urethra involvement).RESULTS: A total of 887 non-metastatic UCB patients were included. Among them, 146 patients underwent urethrectomy at the time of RC. Urethrectomy was performed more often in patients with urethral invasion, T3/4 tumor stage, CIS, positive frozen section analysis of the urethra, and those who received neoadjuvant chemotherapy, underwent robotic RC, and/or received an ileal conduit urinary diversion (all p < 0.001). Estimated blood loss and the postoperative complication rate were comparable between patients who received an urethrectomy and those who did not. Urethrectomy during RC was not associated with PFS (HR 0.83, p = 0.17), CSS (HR 0.93, p = 0.67), or OS (HR 1.08, p = 0.58). In the subgroup of 276 patients at high risk for UR, urethrectomy at the time of RC decreased the risk of progression (HR 0.58, p = 0.04).CONCLUSION: In our study, urethrectomy at the time of RC seems to benefit only patients at high risk for UR. Adequate risk assessment of UCB patients' history may allow for better clinical decision-making and patient counseling.
KW - Carcinoma, Transitional Cell/pathology
KW - Cystectomy
KW - Humans
KW - Male
KW - Retrospective Studies
KW - Urethra/pathology
KW - Urethral Neoplasms/pathology
KW - Urinary Bladder/surgery
KW - Urinary Bladder Neoplasms/pathology
U2 - 10.1007/s00345-022-04025-z
DO - 10.1007/s00345-022-04025-z
M3 - SCORING: Journal article
C2 - 35596017
VL - 40
SP - 1689
EP - 1696
JO - WORLD J UROL
JF - WORLD J UROL
SN - 0724-4983
IS - 7
ER -
