Ureteroscopic management of selected upper tract urothelial carcinoma (UTUC) cases can be an alternative to the gold standard radical nephroureterectomy (RNU), according to a new study.
The findings were based on 168 patients who underwent retrograde ureteroscopy (URS) as the primary treatment for low-grade UTUC. A team led by Demetrius H. Bagley, MD, of Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, found a 5-year cancer-specific survival rate of 92.6% and 5-year overall survival rate of 80.9%. Recurrence-free survival was 30%, with an average tumor size on recurrence of 6.39 mm. The progression-free survival rate was 75%, with a renal preservation rate of 71.4%.
“The use of URS in the treatment of UTUC is associated with long-term patient viability,” the authors concluded in a report published in Urologic Oncology. “URS resulted in a high rate of recurrence but led to renal preservation in 71.4% of patients followed over 5 years. This suggests that URS is an acceptable option for long-term management of low grade UTUC.”
The patient population had a median age of 69.8 years and mean follow-up time of 5.53 years. The maximum follow-up time was 23 years. Of the 168 patients, 107 (66%) were male and 157 (93.4%) were White. The average tumor size on initial excision was 16.8 mm.
“To our knowledge, this cohort represents the largest patient population and length of follow up to date, making our study ideal to make stronger inferences about this rare disease and helping guide treatment,” the authors stated.
Dr Bagley and his colleagues noted that up to 80% of patients with low-risk UTUC continue to undergo RNU even though urology association guidelines endorse the use of kidney-sparing techniques for these patients.
“More must be done to educate urologists on the benefits of renal-sparing procedures for low risk UTUC,” the authors wrote. “In the absence of prospective studies, long-term data add to the knowledge base pointing to the safety and efficacy of URS in the patient population.”
Scotland KB, Hubbard L, Cason D, et al. Long term outcomes of ureteroscopic management of upper tract urothelial carcinoma. Urol Oncol. Published online August 7, 2020. doi:10.1016/j.urolonc.2020.06.027