Risk Assessment of Non-Urinary Tract Recurrence After Radical Nephroureterectomy Based on CheckMate 274 Trial
Tetsuya Shindo1, Yohei Ueki2, Ippei Muranaka3
1Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
Summary
This study identified risk factors for recurrence after radical nephroureterectomy in upper urinary tract carcinoma (UTUC) patients. Findings aid personalized adjuvant treatment decisions for UTUC, potentially reducing unnecessary therapies.
Area of Science:
- Urology
- Oncology
- Clinical Research
Background:
- Upper urinary tract carcinoma (UTUC) recurrence after radical nephroureterectomy (RNU) poses a significant clinical challenge.
- Identifying patients at high risk for non-urinary tract recurrence is crucial for optimizing adjuvant treatment strategies.
- The CheckMate 274 trial established eligibility criteria that may stratify UTUC patients based on recurrence risk.
Purpose of the Study:
- To assess the risk of extra-urinary tract recurrence following RNU in UTUC patients.
- To identify specific risk factors associated with recurrence in both CheckMate 274-eligible and ineligible patient cohorts.
Main Methods:
- Retrospective evaluation of 545 UTUC patients undergoing RNU between 2012 and 2022.
- Recurrence defined as extra-urinary tract events.
- Univariate and multivariable logistic regression analyses to determine risk factors for recurrence, stratified by CheckMate 274 eligibility.
Main Results:
- Overall recurrence rate was 23.3% (127/545 patients).
- For CheckMate 274-eligible patients (n=183), risk factors included preoperative renal dysfunction, lymphovascular invasion, positive resection margin, and positive lymph node status.
- For CheckMate 274-ineligible patients (n=362), risk factors included preoperative ureteroscopy, lymphovascular invasion, specific histological subtypes, and pathological T2 stage.
Conclusions:
- Risk factors for recurrence differ between CheckMate 274-eligible and ineligible UTUC patient groups.
- Personalized discussion of adjuvant treatment needs is warranted based on individual risk profiles.
- These findings support informed decision-making for adjuvant therapy, potentially minimizing overtreatment in UTUC management.
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