SEGMENTAL resection was associated with significantly improved overall and cancer-specific survival compared with local tumour excision among patients undergoing kidney-sparing surgery for upper tract urothelial carcinoma, according to a comparative survival study.
Researchers also developed and externally validated a prognostic tool designed to support individualised surgical decision-making in patients with localised disease.
Kidney-sparing surgery offers an approach to managing upper tract urothelial carcinoma (UTUC), with local tumour excision and segmental resection representing two principal surgical techniques.
However, the optimal procedure remains uncertain, particularly regarding long-term survival outcomes.
To investigate these differences, researchers identified patients with UTUC who underwent kidney-sparing surgery using the Surveillance, Epidemiology, and End Results database.
Participants were categorised according to whether they received local tumour excision or segmental resection.
Propensity score matching was performed to reduce baseline differences between treatment groups, producing a matched cohort of 312 patients.
Researchers subsequently compared overall survival and cancer-specific survival, using multivariable Cox regression analyses to identify independent prognostic factors.
Following propensity score matching, segmental resection demonstrated favourable long-term survival outcomes compared with local tumour excision.
Multivariable analysis identified segmental resection as an independent predictor of improved overall survival (hazard ratio: 0.657; p=0.005).
This corresponded to a 34.3% lower hazard of death from any cause compared with local tumour excision.
Segmental resection was also associated with improved cancer-specific survival (hazard ratio: 0.592; p=0.019), representing a 40.8% lower hazard of cancer-related death.
The observed associations remained consistent across the evaluated clinical subgroups, with no statistically significant evidence of variation between groups (all interaction p>0.05).
These findings suggested that segmental resection may offer survival advantages for selected patients undergoing kidney-sparing treatment for localised UTUC.
Alongside the survival analysis, researchers developed a prognostic nomogram incorporating independent predictors identified through multivariable Cox regression.
The model was subsequently assessed in an independent real-world cohort to evaluate its predictive performance beyond the original study population.
External validation demonstrated favourable discrimination, with a peak area under the curve of 0.852.
The findings suggested that the nomogram could support individualised risk assessment and inform surgical decision-making when considering kidney-sparing approaches.
However, the observational study design means that the reported survival associations cannot establish that segmental resection directly causes better outcomes.
Overall, the researchers concluded that segmental resection may be associated with superior long-term survival compared with local tumour excision, while the validated prognostic model could help guide personalised treatment selection.
Reference
Liu X et al. Survival Outcomes of Segmental Resection Versus Local Tumor Excision in Upper Tract Urothelial Carcinoma: A Population-Based Study. Annals of Surgical Oncology. 2026
Featured image: ikel Taboada on Adobe stock
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
