Endoscopic management versus radical nephroureterectomy for localized upper tract urothelial carcinoma in a high endemic region

Chen, Yung Tai; Yu, Chih-Chin; Yeh, Hsin Chih; Lee, Hsiang Ying; Jiang, Yuan Hong; Lee, Yu-Khun; Kuei, Chia Hao; Wu, Chia Chang; Huang, Chao Yuan; Lin, Weihong; Yang, Cheng Kuang; Tsai, Yao Chou

doi:10.1038/s41598-021-83495-4

Cited by 14 publications

(10 citation statements)

References 20 publications

(10 reference statements)

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“…In this series the rate of ureteral stenosis was 19% in the adjuvant group and 28% in the chemoablation group. These rates appear consistent with published ureteral stenosis rates of 16%-25% in patients treated by ureteroscopic ablation alone 16,17 and lower than the rate of ureteral stenosis (44%) in the OLYMPUS study. 14 Cross-trial comparison should be cautioned as a universal definition of ureteral stenosis surrounding UTUC therapy has yet to be established.…”

Section: Discussionsupporting

confidence: 90%

Efficacy and Safety of Mitomycin Gel (UGN-101) as an Adjuvant Therapy After Complete Endoscopic Management of Upper Tract Urothelial Carcinoma

et al. 2023

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Purpose:We describe a novel application of the reverse thermal polymer gel of mitomycin C (UGN-101) as adjuvant therapy after complete endoscopic ablation of upper tract urothelial carcinoma.Materials and Methods:We retrospectively reviewed patients treated with UGN-101 from 15 high-volume centers. Adjuvant therapy was defined as treatment administered following visually complete endoscopic ablation. Response at primary endoscopic evaluation was defined as no visual tumor or negative biopsy. Ipsilateral disease-free and progression-free survival were estimated by the Kaplan-Meier method. Ureteral stenosis and other adverse events were abstracted from the medical records. Ureteral stenosis was defined as a condition requiring ureteral stent or nephrostomy, or that would typically warrant stent or nephrostomy.Results:Adjuvant UGN-101 after complete endoscopic ablation was used in 52 of 115 (45%) renal units in the oncologic analysis. At first endoscopic evaluation, 36/52 (69%) were without visible disease. At 6.8 months’ median follow-up, the ipsilateral disease-free rate was 63%. Recurrence after adjuvant UGN-101 therapy was more likely in multifocal tumors compared to unifocal (HR 3.3, 95% CI 1.07-9.91). Compared with UGN-101 treatment for chemoablation of measurable disease, there were significantly fewer disease detections with adjuvant therapy (P < .001). Ureteral stenosis after UGN-101 was diagnosed in 10 patients (19%) undergoing adjuvant therapy compared to 17 (29%) undergoing chemoablative therapy (P = .28).Conclusions:In patients being considered for UGN-101, maximal endoscopic ablation prior to UGN-101 treatment may result in fewer patients with disease at first endoscopy and possibly fewer adverse events than primary chemoablative therapy. Longer follow-up is needed to determine if UGN-101 after complete endoscopic ablation will lead to durable disease-free interval.

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Section: Discussionsupporting

confidence: 90%

Efficacy and Safety of Mitomycin Gel (UGN-101) as an Adjuvant Therapy After Complete Endoscopic Management of Upper Tract Urothelial Carcinoma

et al. 2023

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“…In the comparison of the Kaplan–Meier-estimated survival curves, the KSS group was associated with better OS and CSS but demonstrated higher rates of recurrence compared to RNU. However, if bladder recurrence occurred, it was diagnosed significantly earlier in the RNU group, in line with previous findings in the literature ( 27 ). Literature on the evidence for optimal FU intervals is sparse, and given the rarity of UTUC, there is a paucity of guidelines on efficient surveillance.…”

Section: Discussionsupporting

confidence: 91%

Optimization of postoperative surveillance protocols in upper tract urothelial cancer: A retrospective cohort study

Lindner

Pichler²,

Maier³

et al. 2023

Front. Oncol.

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Upper tract urothelial carcinoma (UTUC) is an aggressive disease that is managed by radical or organ-sparing surgery. High recurrence rates require early detection and strict follow-up (FU) protocols. Recommendations are assigned to a low level of evidence. Our aim was to identify time-to-tumor recurrence, analyze the temporal relation to recommended FU regimens, and provide a critical proposal for further surveillance. This retrospective study included 54 patients receiving radical nephroureterectomy (RNU) in high-risk UTUC and 14 patients assigned to kidney-sparing surgery (KSS) with low-risk disease. FU surveillance protocols consisted of close intervals irrespective of the received type of surgery. In total, 68 patients were included with a median FU of 23 months. Mean overall survival (OS) was significantly shorter in RNU compared to KSS (P = .027). Recurrence in the bladder and/or upper urinary tract (UUT) was 57.1% in KSS and 38.9% after RNU (P = .241). Mean recurrence-free survival (RFS) was significantly shorter in RNU patients compared to KSS (22.4 vs. 47.9 months, P = .013), and 76.2% of the recurrences in the RNU group occurred in the first postoperative year. UUT recurrence was diagnosed after a median of 3.0 (RNU) and 25.0 (KSS) months. There was a frequent onset of metastases in the RNU group, with 85.7% in the first year compared to the KSS group with 50%. Multivariable regression analysis showed that the tumor stage was the parameter independently related to OS (P = .002), RFS (P = .008), and metastasis-free survival (MFS, P = .002). In conclusion, surveillance of UTUC should be adapted to real-time occurrence patterns. Strict imaging protocols are recommended in the first two years irrespective of the method of surgery. As recurrence is equally distributed over the years after KSS, cystoscopy should be offered regularly for five years and diagnostic URS for three years. After RNU, cystoscopies should be decreased to yearly intervals after year three. Contralateral UUT should also be examined after RNU.

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“…In UTUCs, surgery is commonly performed with either endoscopic ablation or SU. The treatment outcomes of endoscopic ablation in Taiwan were reported in 2022; however, results for SU are still lacking 9 . Suggestions for localized and high-risk UTUCs in the EAU and NCCN guidelines are ambiguous.…”

Section: Discussionmentioning

confidence: 99%

Segmental ureterectomy outcome of upper tract urothelial carcinoma in a high endemic area: A Taiwan nationwide collaborative study

Wang,

Luo,

Wang

et al. 2024

Urological Science

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Purpose: According to the National Comprehensive Cancer Network guidelines, segmental ureterectomy (SU) of upper tract urothelial carcinoma (UTUC) is a considerable option for selected mid- and distal ureteral urothelial carcinoma (UC). As a UTUC endemic area, Taiwan lacks treatment outcome analysis of SU. Materials and methods: This study retrospectively reviewed the treatment outcomes of SU for clinically localized UTUCs. Patients with biopsy or washing cytology-confirmed UTUCs who underwent open, laparoscopic, or robot-assisted management with curative intent were retrospectively reviewed for the eligibility of analysis. Cox regression was applied for univariable and multivariable analyses. Results: A total of 161 patients who underwent SU were reviewed and analyzed. The median follow-up period was 44.5 (interquartile range, 21.6–84.9) months. After SU, 56/161 (34.8%) patients were free of UTUCs after the follow-up, 25/161 (15.5%) patients had local recurrence, and 35/161 (21.7%) had lymph node or distant metastasis. Surgical margin involvement was a risk factor associated with worse cancer-specific survival. Higher bladder recurrence and local recurrence rates were observed with concurrent bladder UC. Lymphovascular invasion and previous radical nephroureterectomy (RNU) for UC were related to higher local recurrence rates. Patients with pathological T3/T4 stage and end-stage renal disease tended to have higher metastasis rates. For the management of local recurrence, 19 patients received salvage RNU and 25 patients had adjuvant chemotherapy. However, 26/161 (16.1%) patients died of UTUCs and 2/161 (1.2%) patients died of surgery-related complications. Conclusion: SU provides acceptable oncological outcomes if the surgeons select candidates carefully. SU is not recommended if the patient has T3 or higher stage or comorbidity of end-stage renal disease. Concurrent bladder UC is a risk factor for worse bladder recurrence-free survival and local recurrence-free survival. Lymphovascular invasion and previous RNU for UC were related to higher local recurrence rates. After SU, periodic follow-up is mandatory because the local recurrence rate is higher than radical surgery.

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Endoscopic management versus radical nephroureterectomy for localized upper tract urothelial carcinoma in a high endemic region

Cited by 14 publications

References 20 publications

Efficacy and Safety of Mitomycin Gel (UGN-101) as an Adjuvant Therapy After Complete Endoscopic Management of Upper Tract Urothelial Carcinoma

Efficacy and Safety of Mitomycin Gel (UGN-101) as an Adjuvant Therapy After Complete Endoscopic Management of Upper Tract Urothelial Carcinoma

Optimization of postoperative surveillance protocols in upper tract urothelial cancer: A retrospective cohort study

Segmental ureterectomy outcome of upper tract urothelial carcinoma in a high endemic area: A Taiwan nationwide collaborative study

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