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Abstract
Purpose: To evaluate the oncological outcome and complications of patients treated with complete urinary tract extirpation (CUTE) in our department, and to identify prognostic factors for survival.
Methods: Clinico-pathological data of patients treated with one-step or stepwise CUTE between 1999 and 2017 were collected retrospectively. Complications were classified according to the modified Clavien–Dindo classification (CDC) in the early (≤30 days) and late (>30 days) follow-up. Log-rank test was used to assess independent predictors of overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS).
Results: Twenty-five patients (20 male) underwent CUTE (16 one-step) for BC + unilateral/bilateral UTUC. Minor (CDC 1-2) and major (CDC3-5) complications were observed in 72% and 40% of patients, respectively, in the early postoperative period (≤30 days). Five (20%) patients died in the perioperative period (CDC 5) with a median OS of 52 days (range: 25–77). Median time to last follow-up or death was 30 months (range: 0–161). Median OS was 50 months (95% Confidence Interval [CI]: 22–118 months), while median CCS and RFS were not reached. The 5-year OS, CSS and RFS were 42.7%, 69.6% and 66.7%, respectively. A score for determining which patients would benefit from CUTE was arbitrarily developed, and showed that the patients with a score of 0–2 points (good prognosis) had a better OS than the patients with a poor prognosis (3–4 points) in the log-rank test.
Conclusions: Because of lower OS rates, patients with ESRD or with a CUTE score of 3–4 points are probably not ideal candidates for CUTE.
Acknowledgements
Murat Akand is supported by a clinical scholarship from the European Urologic Scholarship Program (EUSP). Steven Joniau is a senior clinical researcher of the Research Foundation of Flanders (FWO).
Ethical approval
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
For this type of study, formal consent is not required.
Disclosure statement
The authors declare that they have no conflict of interest related to this manuscript.