Piruz Motamedinia1,2, Mohamed Keheila1, David A Leavitt1,3, Ardeshir R Rastinehad4, Zeph Okeke1, Arthur D Smith1. 1. 1 Arthur Smith Institute for Urology, North Shore-Long Island Jewish Medical Center, New Hyde Park, New York. 2. 2 Department of Urology, Yale University, New Haven, Connecticut. 3. 3 Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan. 4. 4 Icahn School of Medicine at Mt. Sinai, New York, New York.
Abstract
INTRODUCTION: The gold standard treatment for upper tract urothelial carcinoma (UTUC) is radical nephroureterectomy (RNU). The role of endoscopic resection is limited to low-risk patients. In this study, we present our 30-year experience in the endoscopic management of UTUC. METHODS: In this retrospective study, we identified 141 patients who underwent percutaneous UTUC resection. Demographic and clinical data were collected, including tumor characteristics, bacillus Calmette-Guérin (BCG) and mitomycin use, tumor recurrence, progression to RNU, and overall survival (OS), and compared in univariate and multivariate analyses. RESULTS: Median follow-up was 66 months. Recurrence occurred in 37% of low-grade patients and 63% of high-grade (HG) patients, with a median time to recurrence of 71.4 vs 36.4 months, respectively. Grade was the only predictor of recurrence (HR 2.12, p = 0.018). The latest time to recurrence occurred after 116 months of surveillance. RNU was avoided by 87% of patients. Age, imperative indications for endoscopy, a history of bladder cancer, and tumor stage and grade were predictors of OS; however, in multivariate analysis, grade and stage lost significance. BCG and mitomycin did not protect against recurrence, progression to RNU, or death over resection alone. CONCLUSION: Percutaneous management of UTUC allows for renal preservation in the majority of patients with resectable disease. Patients with HG tumors are more likely to experience recurrence, but are not at an increased risk of death. Intraluminal BCG and mitomycin continue to have a limited adjuvant role to resection. Recurrence may occur many years following initial resection and therefore prolonged surveillance is advised.
INTRODUCTION: The gold standard treatment for upper tract urothelial carcinoma (UTUC) is radical nephroureterectomy (RNU). The role of endoscopic resection is limited to low-risk patients. In this study, we present our 30-year experience in the endoscopic management of UTUC. METHODS: In this retrospective study, we identified 141 patients who underwent percutaneous UTUC resection. Demographic and clinical data were collected, including tumor characteristics, bacillus Calmette-Guérin (BCG) and mitomycin use, tumor recurrence, progression to RNU, and overall survival (OS), and compared in univariate and multivariate analyses. RESULTS: Median follow-up was 66 months. Recurrence occurred in 37% of low-grade patients and 63% of high-grade (HG) patients, with a median time to recurrence of 71.4 vs 36.4 months, respectively. Grade was the only predictor of recurrence (HR 2.12, p = 0.018). The latest time to recurrence occurred after 116 months of surveillance. RNU was avoided by 87% of patients. Age, imperative indications for endoscopy, a history of bladder cancer, and tumor stage and grade were predictors of OS; however, in multivariate analysis, grade and stage lost significance. BCG and mitomycin did not protect against recurrence, progression to RNU, or death over resection alone. CONCLUSION: Percutaneous management of UTUC allows for renal preservation in the majority of patients with resectable disease. Patients with HG tumors are more likely to experience recurrence, but are not at an increased risk of death. Intraluminal BCG and mitomycin continue to have a limited adjuvant role to resection. Recurrence may occur many years following initial resection and therefore prolonged surveillance is advised.
Authors: Michael Metcalfe; Gavin Wagenheim; Lianchun Xiao; John Papadopoulos; Neema Navai; John W Davis; Jose A Karam; Ashish M Kamat; Christopher G Wood; Colin P Dinney; Surena F Matin Journal: J Endourol Date: 2017-07-21 Impact factor: 2.942
Authors: Rao S Mandalapu; Mesut Remzi; Theo M de Reijke; Vitaly Margulis; J Palou; A Kapoor; Ofer Yossepowitch; Jonathan Coleman; Olivier Traxer; J Kyle Anderson; James Catto; Jean de la Rosette; Timothy O'Brien; Anthony Zlotta; Surena F Matin Journal: World J Urol Date: 2016-05-27 Impact factor: 4.226