(UroToday.com) The 37th Annual European Association of Urology Congress held in Amsterdam, the Netherlands between July 1st, and 4th 2022 was host to an abstract session regarding new insights into the management of upper tract urothelial cancer (UTUC). Dr. Nora Hendriks presented the oncologic and renal function outcomes of UTUC patients undergoing kidney sparing surgery (KSS) versus radical nephroureterectomy (RNU) at a single center.
Dr. Hendriks began her presentation by highlighting that UTUC is a rare disease accounting for <5% of all urothelial cancers. RNU remains the gold standard for the treatment of UTUC, however, the role of KSS continues to gain prominence as per current guidelines. The objective of this study was thus to compare the oncologic and renal function outcomes in patients with UTUC treated by KSS or RNU at a tertiary referral center.
This was a retrospective cohort analysis of 180 adult patients (186 kidney units) with non-metastatic UTUC treated with either RNU or KSS (ureterorenoscopy or percutaneous tumor ablation, segmental ureteral resection) at a single tertiary referral center between 2010 and 2020. Patients were risk stratified per the current EAU guidelines for UTUC.
Of the 186 kidney units, 97 (52.2%) were treated with RNU, and 89 (47.8%) were managed with KSS (75 ureteroscopic ablations, 9 segmental resections, and 5 percutaneous ablations). As expected, patients in the RNU group had significantly worse disease features (i.e. tumor size >2 cm, disease multifocality, presence of hydronephrosis, tumor grade and stage), with 86.2% of tumors in the RNU group classified as EAU high risk tumors, compared to 74.4% in the KSS arm (p=0.03).
Overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival (MFS) were all significantly superior in the KSS group when comparing all patients, regardless of risk stratification.
When the analysis was restricted to patients with high-risk disease only per EAU criteria, patients in the RNU high risk subgroup continued to have comparatively worse clinicopathologic features as demonstrated below:
Within the high-risk subgroup, OS (p=0.025), CSS (p=0.023), and MFS (p=0.003) continued to be significantly superior in the KSS arm
Intravesical (p=0.023) and ipsilateral recurrence-free survivals (p=0.000) were however significantly higher in the RNU group.
With regards to post-operative renal function. eGFR was significantly higher in the KSS arm at 3 (60 versus 45 ml/min/1.73m2) and 12 months (60 versus 47 ml/min/1.73m2). These differences were no longer significant at two and five years post-operatively.
Dr. Hendriks concluded as follows:
- Based on the proposed clinical composite risk stratification by the EAU guidelines, patients with high-risk disease should be offered treatment by RNU
- OS, CSS, and MFS are higher in the high risk KSS group, although such patients in this analysis were treated outside guideline recommendations
- Are current risk stratification tools as stated by the EAU guidelines correctly discriminating between high risk and low risk disease when looking at survival outcomes?
Presented by: Nora Hendriks, MD, MS, Resident Physician, Department of Urology, Alrijne Hospital, Leiden and Leiderdorp, Netherlands
Written by: Rashid Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2022 European Association of Urology (EAU) Annual Hybrid Meeting, Amsterdam, NL, Fri, July 1 – Mon, July 4, 2022.