UTUC LANDMARK STUDIES
- POUT - 261 patients with primary UCC. Randomly assigned adjuvant surveillance or four cycles of gemcitabine and either cisplatin or carboplatin (depending on renal function). The early stopping criteria were met and the trial was halted due to a 3-year disease-free survival was 71% in those patients receiving adjuvant chemotherapy as opposed to 54% in those not receiving chemotherapy. Patients with nonmetastatic disease, negative margins, and cisplatin rather carboplatin responded best.
Ureteroscopy in patients who undergo nephroureterctomy for TCC may increase the rate of intravesical recurrence (IVR). Among the 2 382 patients included in the meta‐analysis, 765 underwent diagnostic URS prior to RNU. The IVR rate ranged from 39.2% to 60.7% and from 16.7% to 46% in patients with and without prior URS, respectively. In the pooled analysis, a statistically significant association was found between performance of URS prior to RNU and IVR (HR 1.56, 95% CI 1.33–1.88; P < 0.001). There was no heterogeneity in the observed outcomes, according to the I2 statistic of 2% (P = 0.40). Within the intrinsic limitations of this type of analysis, these findings suggest a significant association between the use of diagnostic URS and higher risk of developing IVR after RNU. Further research in this area should be encouraged to further investigate the possible causality behind this association and it potential clinical implications. (1)