We compared the outcomes in early-stage upper tract urothelial carcinoma (UTUC) patients receiving endoscopic ablation (EA) with radical nephroureterectomy (RNU). From 2004 to 2018, cTa/T1N0M0 UTUC patients undergoing EA and RNU were enrolled. For reducing observational bias, propensity scores based on inverse probability of treatment weighting (IPTW) were utilized for comparing the oncologic outcomes and renal function changes. In total, 65 of 184 cTa/T1 UTUC patients were analyzed after exclusion of 119 patients with end-stage renal disease, and lack of previous ureteroscopic biopsy. The studied patients included 23 who received EA and 42 RNU, and both groups were well balanced after adjusting with IPTW. The median follow-up period was 43.6 months. There was no statistical difference between the two groups in terms of oncological outcome. The EA group exhibited less estimated glomerular filtration rate (eGFR) decline one year later (0.0% vs. 20.2%, p < 0.001) and less worsening of chronic kidney status (13.2% vs. 46.5%, p = 0.026). Among patients receiving EA, high-grade tumors exhibited higher subsequent recurrence in the residual urinary tract than did the low-grade ones. (p = 0.037). In summary, endoscopic ablation preserves renal function without compromising oncological outcome in selected UTUC patients. High-grade tumors should be strictly followed up following endoscopic ablation.
Journal of clinical medicine. 2022 Feb 27*** epublish ***
Chih-Yu Shen, Yeong-Chin Jou, Wei-Chih Kan, Tzong-Shin Tzai, Yuh-Shyan Tsai
Department of Urology, Tainan Hospital, Ministry of Health and Welfare, Tainan City 70043, Taiwan., Department of Urology, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chia-Yi 60002, Taiwan., Department of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Yongkang District, Tainan 710, Taiwan., Department of Urology, Tainan Municipal An-Nan Hospital, Tainan 709, Taiwan., Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.