Reassessing age limits: Outcomes of radical nephroureterectomy in octogenarian patients with upper tract urothelial carcinoma

Abstract

Purpose: To assess whether radical nephroureterectomy (RNU) confers oncologic and perioperative benefit in patients aged 80 years or older with upper tract urothelial carcinoma (UTUC). Materials and Methods: This retrospective cohort study included 710 patients who underwent RNU at a tertiary center from 2003 to 2022. Patients were stratified into octogenarian (OG) (>= 80 years, n=96) and non-octogenarian (NOG) (<80 years, n=614) groups. Demographics, perioperative variables, and oncologic outcomes were compared. Multivariate Cox regression was performed for overall survival and cancer-specific survival (CSS). Results: OG had a higher rate of hypertension (72.9% vs. 50.2%) and lower body mass index (23.6 kg/m(2) vs. 24.5 kg/m(2), p=0.028), with similar pathologic stage and tumor grade compared to NOG. OG were more likely to undergo minimally invasive surgery (84.3% vs. 75.3%, p<0.001). Overall complication rate was higher in OG (68.8% vs. 55.2%, p=0.013), but major complications were not (5.2% vs. 3.3%, p=0.340). At median follow-up of 43.6 months, no difference in CSS was found. Positive surgical margin was the only independent predictor of CSS. Conclusions: RNU can be safely and effectively performed in well-selected OG with UTUC. Age >= 80 years was not associated with inferior CSS outcomes or increased major morbidity.