Sohail Dhanji, MD, clinical research fellow, Department of Urology, University of California San Diego School of Medicine, discusses the investigation of preoperative hypertension as a risk factor in patients undergoing nephroureterectomy for upper tract urothelial carcinoma, as well as other risk factors for mortality in this patient population.

At the 2023 American Urologic Association Annual Meeting, Dhanji and colleagues presented data from a multicenter retrospective analysis that included 865 patients with upper tract urothelial carcinoma who underwent nephroureterectomy. Patient data were drawn from the ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST) database. Dhanji and colleagues concluded that hypertension is an independent risk factor for worsened oncologic and survival outcomes in patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy, and exploration of strategies to improve these outcomes is needed.

Upper tract urothelial carcinoma isn't as widely studied as some other genitourinary malignancies, and identifying risk factors could prompt the design and implementation of strategies to help improve survival outcomes for these patients, Dhanji says.

Upon studying available data from the ROBUUST database, investigators noted that hypertension was repeatedly reported a significant risk factor for mortality in this patient population, Dhanji expands. Although other risk factors were identified, the prevalence of hypertension led to more isolated research on this specific risk factor, he details.

Dhanji and colleagues also noted that positive surgical margins were associated with increased rates of recurrence and worse overall survival. Although patients who were non-Caucasian were found to be at an increased risk for recurrence, there was not an increased risk for all-cause or cancer-specific mortality, Dhanji concludes.

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Sohail Dhanji, MD, discusses the investigation of preoperative hypertension as a risk factor in patients undergoing nephroureterectomy for upper tract urothelial carcinoma, as well as other risk factors for mortality in this patient population.


Dr Dhanji on Hypertension as a Risk Factor for Mortality in Urothelial Cancer

Sohail Dhanji, MD, clinical research fellow, Department of Urology, University of California San Diego School of Medicine, discusses the effect of preoperative hypertension on survival outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma, and the importance of hypertension control in this population.

A multicenter retrospective analysis of 865 patients with upper tract urothelial carcinoma who underwent nephroureterectomy was performed utilizing the ROBotic surgery for Upper tract Urothelial cancer Study (ROBUUST) database. This patient cohort was further divided into those with hypertension (n = 488) and those without (n = 377). The study's primary outcome was all-cause mortality (ACM), and key secondary outcomes were cancer-specific mortality (CSM) and recurrence.

Multivariable cox regression analyses confirmed that hypertension was a significant independent risk factor for ACM, CSM, and recurrence in this patient population, Dhanji says. According to Kaplan-Meier analysis, the 3-year overall survival (OS) rates for patients with and without hypertension were 66.9% and 79.8%, respectively (

 = .003). Additionally, 3-year recurrence-free survival was 48.8% in patients with hypertension vs 60.6% in those without hypertension (

 = .032). Lastly, the frequency of high tumor grade in patients with hypertension was 78.5% vs 69.5% in those without hypertension (

These findings highlight the importance of hypertension management as a strategy to improve survival outcomes for this patient population, Dhanji states. However, it remains to be seen whether these strategies would be most effective if utilized during the initial diagnosis process or after undergoing nephroureterectomy, Dhanji notes. Further research is needed to confirm these findings and explore alternative strategies for hypertension control, Dhanji concludes.

Sohail Dhanji, MD, discusses the effect of preoperative hypertension on survival outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma, and the importance of hypertension control in this population.

Sohail Dhanji, MD

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