Luca Villa1,2, Jonathan Cloutier1, Julien Letendre1, Achilles Ploumidis1, Andrea Salonia2,3, Jean-Nicolas Cornu1, Francesco Montorsi2,3, Olivier Traxer4. 1. Department of Urology, Tenon Hospital, Pierre and Marie Curie University, 4 rue de la Chine, 75970, Paris Cedex 20, France. 2. Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. 3. Università Vita-Salute San Raffaele, Milan, Italy. 4. Department of Urology, Tenon Hospital, Pierre and Marie Curie University, 4 rue de la Chine, 75970, Paris Cedex 20, France. olivier.traxer@tnn.aphp.fr.
Abstract
OBJECTIVES: To evaluate the cancer detection rate (CDR) of an early repeated flexible ureteroscopy (2nd-look-URS) and its impact on the conservative management of patients affected with upper urinary tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: Clinical and surgical data from 41 patients with UTUC who underwent 2nd-look-URS within 60 days of their first URS with concomitant laser tumour photoablation at a single tertiary care referral centre from 2009 to 2013 were retrospectively analyzed. Radical nephroureterectomy was offered during follow-up in case of massive tumour recurrence (defined as a tumour not completely removable only with a conservative approach). Descriptive statistics tested the impact of 2nd-look-URS outcomes on subsequent endoscopic evaluation. Kaplan-Meier curves assessed massive tumour recurrence-free survival (mRFS) rates according to the presence of a tumour at 2nd-look-URS. Cox regression analyses identified predictors of mRFS. RESULTS: CDR at 2nd-look-URS was 51.2 %. CDRs at third URS were 81.3 and 41.2 % in patients with a positive and a negative 2nd-look-URS, respectively (p = 0.02). At a mean (median) follow-up of 34.6 (27.6) months, mRFS rates were 88 and 48 % in patients with negative and positive 2nd-look-URS, respectively (log rank = 0.015). Tumour grade at first URS and 2nd-look-URS outcomes achieved predictor status for mRFS (HR 6.1, 95 % CI 1.42-26.27 and HR 5.39, 95 % CI 1.18-24.66, respectively, all p ≤ 0.03). CONCLUSIONS: 2nd-look-URS-related CDR in conservatively treated UTUC patients was 51.2 %. 2nd-look-URS outcomes affected the findings of both subsequent endoscopic evaluation and mRFS. Further studies are needed to confirm the benefits of this approach in terms of patient outcomes.
OBJECTIVES: To evaluate the cancer detection rate (CDR) of an early repeated flexible ureteroscopy (2nd-look-URS) and its impact on the conservative management of patients affected with upper urinary tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: Clinical and surgical data from 41 patients with UTUC who underwent 2nd-look-URS within 60 days of their first URS with concomitant laser tumour photoablation at a single tertiary care referral centre from 2009 to 2013 were retrospectively analyzed. Radical nephroureterectomy was offered during follow-up in case of massive tumour recurrence (defined as a tumour not completely removable only with a conservative approach). Descriptive statistics tested the impact of 2nd-look-URS outcomes on subsequent endoscopic evaluation. Kaplan-Meier curves assessed massive tumour recurrence-free survival (mRFS) rates according to the presence of a tumour at 2nd-look-URS. Cox regression analyses identified predictors of mRFS. RESULTS:CDR at 2nd-look-URS was 51.2 %. CDRs at third URS were 81.3 and 41.2 % in patients with a positive and a negative 2nd-look-URS, respectively (p = 0.02). At a mean (median) follow-up of 34.6 (27.6) months, mRFS rates were 88 and 48 % in patients with negative and positive 2nd-look-URS, respectively (log rank = 0.015). Tumour grade at first URS and 2nd-look-URS outcomes achieved predictor status for mRFS (HR 6.1, 95 % CI 1.42-26.27 and HR 5.39, 95 % CI 1.18-24.66, respectively, all p ≤ 0.03). CONCLUSIONS: 2nd-look-URS-related CDR in conservatively treated UTUC patients was 51.2 %. 2nd-look-URS outcomes affected the findings of both subsequent endoscopic evaluation and mRFS. Further studies are needed to confirm the benefits of this approach in terms of patient outcomes.
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