Segmental Resection Linked to Better Survival in Kidney-Sparing UTUC Study

A retrospective population-based study compared segmental resection (SR) with local tumor excision (LTE) for upper tract urothelial carcinoma (UTUC) treated with kidney-sparing surgery. In a propensity score-matched cohort of 312 patients, SR was associated with better overall and cancer-specific survival; an externally validated nomogram also showed predictive performance.

Matched cohort included 312 patients
Segmental resection associated with improved survival
External validation nomogram peak AUC was 0.852
Retrospective design limits causal interpretation

Researchers used Surveillance, Epidemiology, and End Results data to compare long-term outcomes after kidney-sparing surgery for UTUC, grouping patients by local tumor excision or segmental resection. After propensity score matching, the analysis included 312 patients. The team assessed overall survival and cancer-specific survival, then developed a prognostic nomogram using multivariable Cox regression and evaluated it in an independent real-world cohort.

Compared with LTE, SR was associated with improved overall survival (hazard ratio 0.657; P=0.005) and cancer-specific survival (hazard ratio 0.592; P=0.019). The association was reported across clinical subgroups, with all interaction P values greater than 0.05. The nomogram achieved a peak area under the curve of 0.852 in external validation.

The findings suggest SR may be associated with more favorable survival among selected patients undergoing kidney-sparing treatment, but do not establish that the procedure causes better outcomes. This was a retrospective, nonrandomized analysis; propensity matching cannot eliminate unmeasured confounding. The results support further evaluation of the prognostic tool, rather than a change in procedure selection on their own.

In practice

For patients with localized UTUC considered for kidney-sparing surgery, this retrospective matched analysis found segmental resection associated with better overall and cancer-specific survival than local tumor excision. It does not prove a causal benefit or establish that SR is preferable for an individual patient: treatment allocation was not randomized, and matching may not remove unmeasured differences between groups. The nomogram's external validation is promising, but these findings alone do not justify changing procedure selection.

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Source

Annals of Surgical Oncology: Survival Outcomes of Segmental Resection Versus Local Tumor Excision in Upper Tract Urothelial Carcinoma: A Population-Based Study ↗

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