TY - JOUR
T1 - Single bladder instillation of gemcitabine versus mitomycin C after minimally invasive radical nephroureterectomy
T2 - A propensity-score match analysis from the ROBUUST 2.0 collaborative group
AU - Bologna, Eugenio
AU - Wu, Zhenjie
AU - Franco, Antonio
AU - Abdollah, Firas
AU - Finati, Marco
AU - Simone, Giuseppe
AU - Tuderti, Gabriele
AU - Licari, Leslie Claire
AU - Correa, Andres F.
AU - Lee, Randall
AU - De Cobelli, Ottavio
AU - Ferro, Matteo
AU - Porpiglia, Francesco
AU - Amparore, Daniele
AU - Checcucci, Enrico
AU - Tufano, Antonio
AU - Perdonà, Sisto
AU - Bhanvadia, Raj
AU - Margulis, Vitaly
AU - Brönimann, Stephan
AU - Singla, Nirmish
AU - Puri, Dhruv
AU - Derweesh, Ithaar H.
AU - Mendiola, Dinno F.
AU - Gonzalgo, Mark L.
AU - Ben-David, Reuben
AU - Mehrazin, Reza
AU - Moon, Sol C.
AU - Rais-Bahrami, Soroush
AU - Yong, Courtney
AU - Sundaram, Chandru P.
AU - Ghoreifi, Alireza
AU - Moghaddam, Farshad S.
AU - Djaladat, Hooman
AU - Ditonno, Francesco
AU - Antonelli, Alessandro
AU - Autorino, Riccardo
N1 - Publisher Copyright:
© 2025 Editorial Office of Asian Journal of Urology
PY - 2025/4
Y1 - 2025/4
N2 - Objective: Radical nephroureterectomy (RNU) is considered the standard of care for patients with high-risk upper tract urothelial carcinoma. Current literature reveals a deficit in direct comparative studies evaluating the efficacy of different chemotherapeutic agents administered in single postoperative instillation following RNU. The primary aim of this study was to compare the bladder recurrence (BR) rates between patients receiving a single instillation of mitomycin C (MMC) versus gemcitabine (Gem) after RNU. Methods: The ROBUUST (ROBotic surgery for Upper tract Urothelial cancer STudy) 2.0 is an international, multicenter registry that aggregates data on patients who have undergone curative surgery for upper tract urothelial carcinoma across participating centers from January 2015 to December 2022. Data including primary baseline variables of the patients, characteristics of the tumors, surgical management, and definitive histopathological characterizations were collected and stratified based on the type of postoperative bladder instillation: MMC (the MMC group) and Gem (the Gem group). We selected variables correlated with our primary outcome to conduct a propensity-score match analysis. Results: One hundred patients in the MMC group were matched 1:1 with 100 patients in the Gem group. At 36 months of follow-up, 30 patients in the MMC group and 39 patients in the Gem group experienced BR, representing recurrence rates of 30% and 39%, respectively (p=0.2). The Cox proportional hazards model comparing BR between the groups revealed a hazard ratio of 1.58 (95% confidence interval: 0.98–2.55) with a non-statistically significant increased risk of BR in the Gem group compared with the MMC group (p=0.059). Conclusion: A single perioperative instillation of Gem or MMC seems to offer similar efficacy in reducing the risk of BR in patients undergoing RNU. Further research, ideally within the framework of prospective studies, is warranted to elucidate the optimal chemotherapeutic approach in this setting.
AB - Objective: Radical nephroureterectomy (RNU) is considered the standard of care for patients with high-risk upper tract urothelial carcinoma. Current literature reveals a deficit in direct comparative studies evaluating the efficacy of different chemotherapeutic agents administered in single postoperative instillation following RNU. The primary aim of this study was to compare the bladder recurrence (BR) rates between patients receiving a single instillation of mitomycin C (MMC) versus gemcitabine (Gem) after RNU. Methods: The ROBUUST (ROBotic surgery for Upper tract Urothelial cancer STudy) 2.0 is an international, multicenter registry that aggregates data on patients who have undergone curative surgery for upper tract urothelial carcinoma across participating centers from January 2015 to December 2022. Data including primary baseline variables of the patients, characteristics of the tumors, surgical management, and definitive histopathological characterizations were collected and stratified based on the type of postoperative bladder instillation: MMC (the MMC group) and Gem (the Gem group). We selected variables correlated with our primary outcome to conduct a propensity-score match analysis. Results: One hundred patients in the MMC group were matched 1:1 with 100 patients in the Gem group. At 36 months of follow-up, 30 patients in the MMC group and 39 patients in the Gem group experienced BR, representing recurrence rates of 30% and 39%, respectively (p=0.2). The Cox proportional hazards model comparing BR between the groups revealed a hazard ratio of 1.58 (95% confidence interval: 0.98–2.55) with a non-statistically significant increased risk of BR in the Gem group compared with the MMC group (p=0.059). Conclusion: A single perioperative instillation of Gem or MMC seems to offer similar efficacy in reducing the risk of BR in patients undergoing RNU. Further research, ideally within the framework of prospective studies, is warranted to elucidate the optimal chemotherapeutic approach in this setting.
KW - Adjuvant therapy
KW - Bladder instillation
KW - Gemcitabine
KW - Mitomycin C
KW - Upper tract urothelial cancer
UR - https://www.scopus.com/pages/publications/105000271932
U2 - 10.1016/j.ajur.2024.10.006
DO - 10.1016/j.ajur.2024.10.006
M3 - Article
AN - SCOPUS:105000271932
SN - 2214-3882
VL - 12
SP - 250
EP - 257
JO - Asian Journal of Urology
JF - Asian Journal of Urology
IS - 2
ER -