BACKGROUND: Radical nephroureterectomy (RNU) with bladder cuff excision (BCE) is the surgical principle adopted for the treatment of upper tract urothelial cancers (UTUCs). However, not all RNUs are performed with BCE. We quantified the prognostic impact of RNU with BCE on cancer-specific survival (CSS) in a large patient population. METHODS: In total, 505 patients with UTUC were enrolled from four different institutions. The clinicopathological parameters of patients who underwent RNU with and without BCE were compared. The Kaplan-Meier and multivariate Cox regression analyses were performed to assess the influence of BCE on CSS. RESULTS: In total, 60 (11.9%) patients had not undergone BCE during RNU. Compared to patients who underwent BCE, these patients were older and had more comorbidities. Patients with UTUC who had not undergone BCE were more likely to be associated with ≥pT3, margin positivity, and renal pelvis localization compared to patients who underwent BCE. Median follow-up periods were 30.5 months (range, 6-144 months). The Kaplan-Meier estimates revealed that BCE during RNU was not significantly associated with CSS in all UTUC patients and in the subgroup with renal pelvis localization; however, patients who underwent RNU without BCE had significantly worse CSS rates compared to patients who underwent RNU with BCE in the subgroup analysis of patients with ureteral cancer. Multivariate analysis identified BCE as an independent prognostic factor of CSS in patients with ureteral cancer. CONCLUSIONS: In the present study, RNU without BCE resulted in significantly worse CSS in ureteral cancer patients, which indicated that BCE should be mandatory in patients with ureteral cancer.
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