Conservative management in selected patients with upper tract urothelial carcinoma compares favourably with early radical surgery

Abstract

OBJECTIVE To compare the outcomes of patients treated for upper tract urothelial carcinoma with either immediate nephroureterectomy (NU) or initial endoscopic management. PATIENTS AND METHODS The treatments of 108 patients (120 renal units) at the authors’ institution were retrospectively reviewed and divided into two groups, i.e. those who received immediate NU and those who had conservative initial therapy, which included renal units solely treated with endoscopy with or without delayed NU. Overall and disease‐specific survival (DSS) were compared between the treatment groups. RESULTS There were 48 low‐grade tumours, of which 27 (56%) were managed conservatively and 21 (44%) by immediate NU. Seven patients treated conservatively had stage or grade progression and had delayed NU. The mean (sd) DSS at 5 years in patients with low‐grade disease was equally good for conservative treatment and immediate NU, at 86.2 (9.1)% vs 87.4 (8.4)% (P = 0.909). There were 68 high‐grade tumours, of which 12 (18%) patients had conservative management and 56 (82%) had immediate NU. Among the former, seven of 12 had a solitary kidney and three had bilateral disease. In patients managed endoscopically, four of 30 (13%) required delayed NU. The DSS for the conservative and immediate NU groups were 68.6 (18.6)% vs 75.0 (8.1)% (P = 0.528). CONCLUSION Management with a conservative approach in selected patients provides comparable outcomes to immediate NU in patients with low‐grade disease.

Ureterectomía radical distal por cáncer urotelial y reconstrucción ureteral asistida por robot

“…Estas técnicas fueron primeramente descritas en pacientes seleccionados tales como monorrenos, con insuficiencia renal o con tumores bilaterales. Al demostrar resultados oncológicos comparables a la NUR 10 , aquellos pacientes con unidad renal contralateral normal y tumores de uréter distal, sobre todo de bajo grado de malignidad histológica, podrían ser candidatos a cirugía conservadora. Éstas pueden ir desde la resección endoscópica hasta la ureterectomía distal con neoimplante vesicoureteral mediante diferentes técnicas.…”

Kidney-sparing Management Versus Nephroureterectomy for Upper Tract Urothelial Carcinoma: a Systematic Review and Meta-analysis

“…Hence, we selected the one with more areas and patients. After rounds of screening, twenty-three studies including 1587 KS and 3996 NU patients were enrolled meta-analysis at last (Hall et al, 1998;Shiraishi et al, 2003;Chen et al, 2005;Roupret et al, 2006;Giannarini et al, 2007;Lehmann et al, 2007;Lucas et al, 2008;Dragicevic et al, 2009;Gadzinski et al, 2010;Jeldres et al, 2010;Raymundo et al, 2011;Bin et al, 2012;Bing-bing et al, 2012;Colin et al, 2012;Grasso et al, 2012;Bagrodia et al, 2013;Cutress et al, 2013;Fajkovic et al, 2013;Klatte et al, 2013;Dalpiaz et al, 2014;Fukushima et al, 2014;Hoffman et al, 2014;Hung et al, 2014). All included studies were retrospective comparative study; no randomized controlled trials were identified.…”

Reply

“…the 20q13.2 gain [5]. Moreover, the possible importance of many other molecules has been suggested and it is likely that in the next 5-10 years there could be a group of molecular and genetic markers [1]. They suggested conservative treatment followed by strict surveillance and delayed NU when progression will not compromise the oncological outcome, especially for patients with low-grade disease.…”