Ureteral urothelial carcinoma is a relatively uncommon cancer of the upper urinary tract, but choosing the most appropriate surgical strategy can be challenging. Radical nephroureterectomy provides oncologic control by removing the kidney, ureter, and bladder cuff, whereas kidney-sparing surgery aims to preserve renal function. For many patients and clinicians, the key question is how to balance cancer control against kidney preservation. A research team from Peking University People's Hospital conducted a population-based study using the Surveillance, Epidemiology, and End Results database. The study included 2841 patients with primary ureteral urothelial carcinoma diagnosed between 2000 and 2021. To reduce baseline differences between treatment groups, the researchers used propensity score matching, generating a matched cohort of 1646 patients.
"In ureteral cancer, whether to preserve the organ or eradicate the tumor has always been a controversy" said the study's lead author Yuxuan Song, an urologist surgeon at the Department of Urology at Peking University People's Hospital.
This research was published in Medicine Plus.
Before matching, overall survival and cancer-specific survival did not differ significantly between kidney-sparing surgery and radical nephroureterectomy. After matching, radical nephroureterectomy was associated with better overall survival and cancer-specific survival than kidney-sparing surgery. Exploratory subgroup analyses suggested that this association was more apparent in patients with T1/N0/M0 disease, patients who did not undergo lymph node dissection, patients with tumors measuring 5–10 cm, and those diagnosed in more recent years.
Song emphasized that these findings should be interpreted as associations from a retrospective registry-based study, not as definitive evidence that one operation is universally superior. Because kidney-sparing surgery includes several different procedures and the SEER database lacks detailed information on renal function, recurrence, operative factors, and quality of life, further studies are needed to refine patient selection.
