Session: MP47: Kidney Cancer: Localized: Surgical Therapy II
MP47-04: Hypertension is Associated with Worsened Oncological Survival Outcomes in Patients Undergoing Nephroureterectomy for Upper Tract Urothelial Carcinoma: Analysis of the ROBUUST Registry
Introduction: Impact of hypertension (HTN) on oncologic outcomes in upper tract urothelial carcinoma (UTUC) is uncertain with emerging reports suggesting risk with respect to intravesical recurrence after Radical Nephroureterectomy (RNU). We sought to analyze the impact of HTN on UTUC outcomes in a contemporary cohort of patients who underwent RNU. Methods: We performed a multi-center retrospective analysis of patients who underwent RNU for UTUC utilizing the ROBUUST (ROBotic surgery for Upper tract Urothelial cancer STudy) database. Primary outcome was all-cause mortality (ACM); secondary outcomes were cancer-specific mortality (CSM) and recurrence. The cohort was divided into groups based on hypertension status for analyses. Multivariable cox regression analyses were conducted to elucidate predictors for outcomes, and Kaplan-Meier analyses (KMA) were performed to analyze for overall (OS), cancer-specific (CSS) and recurrence-free survival (RFS) stratified by HTN status. Results: We analyzed 865 patients (488 with hypertension/377 without hypertension; mean follow up 30.5 months). Comparing patients with hypertension versus those without, there was no significant difference in percentage of male gender (59.8% vs 59.2%, p=0.839), mean age (72.12 vs 68.57, p=0.086), tumor size (3.8 vs. 4.0 cm, p=0.425) or positive margin rate (5.3% vs 4.8%, p=0.713) between the cohorts, while patients with hypertension had a significantly greater rate of high tumor grade (78.5% vs 69.5%, p=0.005). Multivariable analysis demonstrated hypertension to be an independent risk factor for worsened ACM (HR 1.83, p=0.013, CSM (HR 2.41, p=0.010) and recurrence (HR 1.41, p=0.022). KMA comparing patients with hypertension versus patients without hypertension, revealed significantly lower 3-year OS (66.9% vs 79.8%, p=0.003), 3-year CSS (77.2% vs 87.5%, p=0.030), and 3-year PFS (48.8% vs. 60.6%, p=0.032) for patients with hypertension. Conclusions: Hypertension is an independent risk factor for worsened oncologic and survival outcomes in patients undergoing RNU for UTUC. Further investigation is warranted to confirm these findings and elucidate mechanisms of action and explore strategies to improve outcomes with improved control of hypertension. SOURCE OF Funding: N/A
