Comparative Analysis of Oncologic Outcomes: Kidney-Sparing Surgery versus Radical Nephroureterectomy for Localized High-Risk Upper Tract Urothelial Carcinoma

Background The kidney-sparing surgery (KSS) technique for upper tract urothelial carcinoma (UTUC) shows potential, yet its efficacy in treating high-risk UTUC is a topic of debate. This study seeks to assess and compare the impact of KSS versus radical nephroureterectomy (RNU) on renal function and long-term oncological outcomes in patients with localized high-risk UTUC. Methods This study retrospectively analyzed 115 patients diagnosed with high-risk UTUC and treated with KSS or RNU in the First Affiliated Hospital of Chongqing Medical University from January 2018 to June 2024. The primary endpoint of this study was overall survival (OS). Secondary endpoints included disease-free survival (DFS), metastasis-free survival (MFS), intravesical recurrence-free survival (IVRFS), and postoperative renal function changes. Additionally, predictors of OS, DFS, MFS, and IVRFS were evaluated through Cox regression models. Results There were no significant differences in the 5-year OS (80.7% vs 70.9%), DFS (46.9% vs 50.5%), MFS (75.3% vs 68.3%), and IVRFS (71.3% vs 69.3%) rates between the KSS and RNU groups, which included 29 and 86 patients, respectively. 6 months after intervention, renal function decreased significantly in RNU group, but not in KSS group. In univariate Cox regression analysis, the surgical procedure did not exhibit significant associations with OS, DFS, MFS, or IVRFS. Subsequent multivariable Cox regression analysis revealed that preoperative creatinine levels, pathological stage, and intraoperative bleeding emerged as independent predictors of OS. Moreover, pathological stage was also an independent predictor for DFS and MFS. Conclusions KSS exhibits similar oncological efficacy as RNU in managing localized high-risk UTUC, with less damage to patients and benefit of better preservation of renal function. Adverse factors such as elevated preoperative creatinine levels, advanced pathological stage, and increased intraoperative blood loss may correlate with inferior overall survival. Additional prospective research is necessary to confirm the validity of our findings.