Treatment strategies for upper tract urothelial carcinoma (UTUC) of a solitary kidney: a single-institutional analysis of 61 cases.

OBJECTIVE: To explore the treatment strategies for patients with upper tract urothelial carcinoma (UTUC) of a solitary kidney.
METHODS: A retrospective analysis of 61 cases who underwent operation for UTUC of a solitary kidney from 2000 to 2012 was performed. Radical nephroureterectomy (RNU) or conservative management was performed. Patients were divided into three groups according to preoperative renal function: group A (eGFR ≥ 60 mL/min), group B (15 mL/min ≤ eGFR < 60 mL/min) and group C (eGFR < 15 mL/min). We analyzed treatment outcomes of patients with different renal function and surgical approaches.
RESULTS: No significant complications were observed, and short-time recovery after operation was satisfactory in all patients. The 5-year cancer-specific survival (CSS) rates for the groups A, B and C were 92.9, 75.3 and 63.7 %, respectively (p = 0.683). The 5-year overall survival (OS) and recurrence-free survival rates were 92.9 and 53 % for group A, respectively, 75.3 and 64.8 % for group B, respectively, and 63.7 and 29.5 % for group C, respectively (all p > 0.1). The conservative management arm was associated with older age (p = 0.002), smaller tumor size (p = 0.013), lack of renal replacement history (p = 0.007) and better preoperative renal function (p = 0.002). There were no significant differences in 5-year CSS, OS or recurrence-free survival between the RNU and conservative management groups. Long-term hemodialysis was required in only three patients in the conservative management arm.
CONCLUSION: Long-term oncological outcomes after conservative management are comparable to RNU in selected cases, and conservative management should be considered an alternative treatment measure. Preoperative renal function and clinicopathological characteristics are important in surgery selection for patients with UTUC of a solitary kidney.