Nearly one-quarter of patients aged 80 years or older with localized upper tract urothelial carcinoma (UTUC) are managed nonsurgically, according to study findings presented at the 2022 American Urological Association annual meeting in New Orleans, Louisiana.
The median overall survival (OS) for these patients is 12 months from diagnosis, Syed Rahman, MD, of the Yale School of Medicine in New Haven, Connecticut, and colleagues reported in a poster presentation.
The investigators noted that treatment decisions in elderly patients with UTUC can be challenging because of their advanced age and medical comorbidities.
“Although, a survival benefit was identified with treatment in high- and low-grade cohorts, it is still important to note that the non-operative groups had a median OS of 12 months,” Dr Rahman said in an interview. “This will be useful for counseling patients that may be poor surgical candidates and that may have a short life expectancy to begin with.”
Using 2004-2015 data from the Surveillance, Epidemiology, and End Results (SEER) database, the investigators identified 528 patients aged 80 years or older with localized UTUC. Of these, 240 received definitive surgery (35.4%), 122 underwent endoscopic ablation (18%), and 166 (24.6%) received no treatment and instead were managed expectantly.
Significantly more patients managed expectantly were 85 years or older compared with patients who received definitive surgery or ablation (59.6% vs 39.6% and 37.7%, respectively). The no-surgery group also were more likely to have low-grade tumors (73.5% vs 37.1% surgery and 41.0% ablation).
Among patients with low-grade tumors, the expectant management group had a significantly lower 3-year disease specific survival (DSS) rate compared with the groups undergoing definitive surgery and ablation (19% vs 51% and 47%, respectively). For those with high-grade tumors, the 3-year DSS rate was 7% vs 38% and 29%, respectively.
Compared with expectant management, definitive surgery and ablation were significantly associated with 56% and 53% decreased risk for death, respectively, according to the investigators.
The preferred option in patients aged 80 years or older depends on a myriad of factors. “If they are functionally well and are good surgical candidates, intervention should be sought after and shows a survival benefit,” Dr Rahman said. “However, if they have a short life expectancy and are poor surgical candidates then a watchful waiting approach may be discussed with the patient using the above data.”
Rahman S, Syed J, Lokeshwar S, Choksi, Raman J, Leapman M. Survival among elderly patients with localized upper tract urothelial carcinoma managed with observation. Presented at AUA 2022, May 13-16, 2022, New Orleans, Louisiana. Poster MP40-14.