Single bladder instillation of gemcitabine versus mitomycin C after minimally invasive radical nephroureterectomy: A propensity-score match analysis from the ROBUUST 2.0 collaborative group
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 postoper...
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Elsevier
2025-04-01
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| author | Eugenio Bologna Zhenjie Wu Antonio Franco Firas Abdollah Marco Finati Giuseppe Simone Gabriele Tuderti Leslie Claire Licari Andres F. Correa Randall Lee Ottavio De Cobelli Matteo Ferro Francesco Porpiglia Daniele Amparore Enrico Checcucci Antonio Tufano Sisto Perdonà Raj Bhanvadia Vitaly Margulis Stephan Brönimann Nirmish Singla Dhruv Puri Ithaar H. Derweesh Dinno F. Mendiola Mark L. Gonzalgo Reuben Ben-David Reza Mehrazin Sol C. Moon Soroush Rais-Bahrami Courtney Yong Chandru P. Sundaram Alireza Ghoreifi Farshad S. Moghaddam Hooman Djaladat Francesco Ditonno Alessandro Antonelli Riccardo Autorino |
| author_facet | Eugenio Bologna Zhenjie Wu Antonio Franco Firas Abdollah Marco Finati Giuseppe Simone Gabriele Tuderti Leslie Claire Licari Andres F. Correa Randall Lee Ottavio De Cobelli Matteo Ferro Francesco Porpiglia Daniele Amparore Enrico Checcucci Antonio Tufano Sisto Perdonà Raj Bhanvadia Vitaly Margulis Stephan Brönimann Nirmish Singla Dhruv Puri Ithaar H. Derweesh Dinno F. Mendiola Mark L. Gonzalgo Reuben Ben-David Reza Mehrazin Sol C. Moon Soroush Rais-Bahrami Courtney Yong Chandru P. Sundaram Alireza Ghoreifi Farshad S. Moghaddam Hooman Djaladat Francesco Ditonno Alessandro Antonelli Riccardo Autorino |
| author_sort | Eugenio Bologna |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-aa9dd4e558ae4d76982da73c0f4af2dc |
| institution | OA Journals |
| issn | 2214-3882 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
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| series | Asian Journal of Urology |
| spelling | doaj-art-aa9dd4e558ae4d76982da73c0f4af2dc2025-08-20T02:14:24ZengElsevierAsian Journal of Urology2214-38822025-04-0112225025710.1016/j.ajur.2024.10.006Single bladder instillation of gemcitabine versus mitomycin C after minimally invasive radical nephroureterectomy: A propensity-score match analysis from the ROBUUST 2.0 collaborative groupEugenio Bologna0Zhenjie Wu1Antonio Franco2Firas Abdollah3Marco Finati4Giuseppe Simone5Gabriele Tuderti6Leslie Claire Licari7Andres F. Correa8Randall Lee9Ottavio De Cobelli10Matteo Ferro11Francesco Porpiglia12Daniele Amparore13Enrico Checcucci14Antonio Tufano15Sisto Perdonà16Raj Bhanvadia17Vitaly Margulis18Stephan Brönimann19Nirmish Singla20Dhruv Puri21Ithaar H. Derweesh22Dinno F. Mendiola23Mark L. Gonzalgo24Reuben Ben-David25Reza Mehrazin26Sol C. Moon27Soroush Rais-Bahrami28Courtney Yong29Chandru P. Sundaram30Alireza Ghoreifi31Farshad S. Moghaddam32Hooman Djaladat33Francesco Ditonno34Alessandro Antonelli35Riccardo Autorino36Department of Urology, Rush University Medical Center, Chicago, IL, USA; Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, ItalyDepartment of Urology, Changhai Hospital, Naval Medical University, Shanghai, ChinaDepartment of Urology, Rush University Medical Center, Chicago, IL, USA; Department of Urology, Sant’Andrea Hospital, La Sapienza University, Rome, ItalyVattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USAVattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USADepartment of Urology, IRCCS Regina Elena National Cancer Institute, Rome, ItalyDepartment of Urology, IRCCS Regina Elena National Cancer Institute, Rome, ItalyDepartment of Urology, Rush University Medical Center, Chicago, IL, USA; Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, ItalyFox Chase-Temple Urologic Institute, Philadelphia, PA, USAFox Chase-Temple Urologic Institute, Philadelphia, PA, USADivision of Urology, European Institute of Oncology-IRCCS, Milan, ItalyDivision of Urology, European Institute of Oncology-IRCCS, Milan, ItalyDivision of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy; Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, ItalyDivision of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, ItalyDepartment of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, ItalyIstituto Nazionale Tumori di Napoli, IRCCS Fondazione G. Pascale, Naples, ItalyIstituto Nazionale Tumori di Napoli, IRCCS Fondazione G. Pascale, Naples, ItalyDepartment of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USABrady Urological Institute, School of Medicine, Johns Hopkins Medicine, Baltimore, MD, USABrady Urological Institute, School of Medicine, Johns Hopkins Medicine, Baltimore, MD, USADepartment of Urology, UC San Diego School of Medicine, La Jolla, CA, USADepartment of Urology, UC San Diego School of Medicine, La Jolla, CA, USADesai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USADesai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USADepartment of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USADepartment of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USADepartment of Urology, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USADepartment of Urology, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USADepartment of Urology, Indiana University, Indianapolis, IN, USADepartment of Urology, Indiana University, Indianapolis, IN, USANorris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USANorris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USANorris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USADepartment of Urology, University of Verona, Verona, ItalyDepartment of Urology, University of Verona, Verona, ItalyDepartment of Urology, Rush University Medical Center, Chicago, IL, USA; Corresponding author.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.http://www.sciencedirect.com/science/article/pii/S2214388225000013Upper tract urothelial cancerBladder instillationAdjuvant therapyGemcitabineMitomycin C |
| spellingShingle | Eugenio Bologna Zhenjie Wu Antonio Franco Firas Abdollah Marco Finati Giuseppe Simone Gabriele Tuderti Leslie Claire Licari Andres F. Correa Randall Lee Ottavio De Cobelli Matteo Ferro Francesco Porpiglia Daniele Amparore Enrico Checcucci Antonio Tufano Sisto Perdonà Raj Bhanvadia Vitaly Margulis Stephan Brönimann Nirmish Singla Dhruv Puri Ithaar H. Derweesh Dinno F. Mendiola Mark L. Gonzalgo Reuben Ben-David Reza Mehrazin Sol C. Moon Soroush Rais-Bahrami Courtney Yong Chandru P. Sundaram Alireza Ghoreifi Farshad S. Moghaddam Hooman Djaladat Francesco Ditonno Alessandro Antonelli Riccardo Autorino Single bladder instillation of gemcitabine versus mitomycin C after minimally invasive radical nephroureterectomy: A propensity-score match analysis from the ROBUUST 2.0 collaborative group Asian Journal of Urology Upper tract urothelial cancer Bladder instillation Adjuvant therapy Gemcitabine Mitomycin C |
| title | Single bladder instillation of gemcitabine versus mitomycin C after minimally invasive radical nephroureterectomy: A propensity-score match analysis from the ROBUUST 2.0 collaborative group |
| title_full | Single bladder instillation of gemcitabine versus mitomycin C after minimally invasive radical nephroureterectomy: A propensity-score match analysis from the ROBUUST 2.0 collaborative group |
| title_fullStr | Single bladder instillation of gemcitabine versus mitomycin C after minimally invasive radical nephroureterectomy: A propensity-score match analysis from the ROBUUST 2.0 collaborative group |
| title_full_unstemmed | Single bladder instillation of gemcitabine versus mitomycin C after minimally invasive radical nephroureterectomy: A propensity-score match analysis from the ROBUUST 2.0 collaborative group |
| title_short | Single bladder instillation of gemcitabine versus mitomycin C after minimally invasive radical nephroureterectomy: A propensity-score match analysis from the ROBUUST 2.0 collaborative group |
| title_sort | single bladder instillation of gemcitabine versus mitomycin c after minimally invasive radical nephroureterectomy a propensity score match analysis from the robuust 2 0 collaborative group |
| topic | Upper tract urothelial cancer Bladder instillation Adjuvant therapy Gemcitabine Mitomycin C |
| url | http://www.sciencedirect.com/science/article/pii/S2214388225000013 |
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