論文種別	原著(症例報告除く)
言語種別	英語
査読の有無	その他(不明)
表題	Oncological outcomes of radical nephroureterectomy with or without lymphadenectomy and neoadjuvant therapy in cN+ UTUC: Insights from the ROBUUST registry.
掲載誌名	正式名：European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 略　 称：Eur J Surg Oncol ISSNコード：15322157/07487983
掲載区分	国外
巻・号・頁	52(10),pp.112033
著者・共著者	Francesco Passaro, Roberto Contieri, Antonio Tufano, Gianluca Spena, Gabriele Bignante, Srinivas Vourganti, Giuseppe Simone, Gabriele Tuderti, Zhenjie Wu, Linhui Wang, Mark L Gonzalgo, Omri Falik Nativ, Alireza Dehghanmanshadi, Soroush Rais-Bahrami, Matteo Ferro, Ottavio de Cobelli, Chandru P Sundaram, Daniel A Sidhom, Takashi Yoshida, Hidefumi Kinoshita, Saum Ghodoussipour, Melinda Fu, James Porter, Randall Lee, Andres F Correa, Alireza Ghoreifi, Farshad S Moghaddam, Hooman Djaladat, Dhruv Puri, Ithaar H Derweesh, Jacob Taylor, Vitaly Margulis, Taibo Li, Nirmish Singla, Ahmed Eraky, Reza Mehrazin, Andrea Minervini, Andrea Mari, Luca Lambertini, Cristian Fiori, Daniele Amparore, Enrico Checcucci, Francesco Porpiglia, Alessandro Veccia, Francesco Ditonno, Alessandro Antonelli, Firas Abdollah, Riccardo Autorino, Sisto Perdonà
発行年月	2026/07
概要	OBJECTIVES:To evaluate the clinical and oncologic outcomes of patients with clinically node-positive (cN+) upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU), with or without neoadjuvant therapy (NAT) and lymphadenectomy (LND), using data from the international RObotic surgery for Upper tract Urothelial cancer STudy (ROBUUST) registry.METHODS:This retrospective study queried the ROBUUST registry, including 242 patients with cN + UTUC who underwent RNU between 2017 and 2024 across 17 institutions. Patients were stratified based on receipt of NAT and/or LND. Clinical, pathological, and follow-up data were analyzed. Primary endpoints included overall survival (OS) and cancer-specific survival (CSS), while metastasis-free survival (MFS) was a secondary endpoint. Survival outcomes were estimated using Kaplan-Meier curves and Cox regression analyses.RESULTS:Among 2733 patients, 242 (8.8%) had cN + disease and were included. Median age was 69 years; 86% underwent LND and 27.6% received NAT. At pathology, 43.7% of LND patients were pN+, and NAT was associated with a higher rate of pN0 status (65% vs. 41%). After a median follow-up of 25.8 months, 12- and 24-month OS were 71% and 60%, respectively. On multivariable analysis, pN + status, tumor location, and ≥pT3 stage were associated with worse OS and CSS, while receipt of NAT was independently associated with improved OS (HR 0.52, p = 0.016) and CSS (HR 0.47, p = 0.020). LND was not independently associated with survival benefit. Sensitivity analysis showed improved OS in patients receiving both NAT and LND compared to LND alone.CONCLUSIONS:In patients with cN + UTUC, NU as part of a multimodal strategy was associated with favorable short-term oncologic outcomes. Neoadjuvant therapy significantly improved survival, supporting its integration into the treatment paradigm for this high-risk group. Further prospective studies are warranted to optimize patient selection and treatment sequencing.
DOI	10.1016/j.ejso.2026.112033
PMID	42570349