Many patients with upper tract urothelial carcinoma (UTUC) outside of the low-risk criteria may possess low absolute risks of distant progression. Herein, we hypothesized that careful selection of high-risk patients undergoing an endoscopic approach could result in acceptable oncological outcomes.
Patients with high-risk UTUC managed endoscopically between 2015 and 2021 were retrospectively identified from a prospectively maintained single academic institution database. Elective and imperative indications for endoscopic treatment were considered. Regarding elective indications, the decision to perform endoscopic treatment was systematically proposed to high-risk patients in whom macroscopically complete ablation was deemed feasible, excluding invasive appearance on CT-scan, and without histological variant.
A total of 60 patients with high-risk UTUC met our inclusion criteria (29 imperative and 31 elective indications). The median follow-up in patients without any event was 36 months. At 5 years, the estimated overall survival, cancer-specific survival, metastasis-free survival, UTUC recurrence-free survival, radical nephroureterectomy-free survival and bladder recurrence-free survival was 57% (41-79), 75% (57-99), 86% (71-100), 56% (40-76), 81% (70-93), and 69% (54-88), respectively. All oncological outcomes were similar between patients with elective and imperative indications (all log rank p>0.05).
In conclusion, we report the first large series of endoscopic treatment in patients with high-risk UTUC, arguing that promising oncologic outcomes can be achieved in properly selected candidates. We encourage multi-institutional collaborative work as a large cohort of high-risk patients treated endoscopically may allow subgroup analyses to define the best candidates.
Journal of endourology. 2023 Jun 13 [Epub ahead of print]
Michael Baboudjian, Angelo Territo, Andrea Gallioli, Paolo Verri, Julia Aumatell, Paula Izquierdo, Alessandro Uleri, Alessandro Tedde, Giuseppe Basile, Josep Maria Gaya, Jorge Huguet, Oscar Rodriguez-Faba, Francesco Sanguedolce, Ferran Algaba, Joan Palou Redorta, Alberto Breda
Aix-Marseille Universite, 128791, Department of Urology and Renal transplantation, Marseille, Provence-Alpes-Côte d'Azu, France., Fundacio Puigvert, 16444, Urology, Barcelona, Catalunya, Spain; ., La Fondazione IRCCS Ospedale Maggiore Policlinico, 9339, Urology, Via della Commenda 15, Milano, Milano, Italy, 20122; ., Fundacio Puigvert, 16444, urology, Barcelona, Catalunya, Spain; ., Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain, Department of Urology , Barcelona, Spain; ., Fundacio Puigvert, 16444, Urology, Barcelona, Catalunya, Spain; ., Fundacio Puigvert, 16444, Barcelona, Catalunya, Spain; ., Fundacio Puigvert, 16444, Urology, Barcelona, Catalunya, Spain; ., Department of Urology, San Raffaele Scientific Institute, Milan, Division of Experimental Oncology/Unit of Urology; URI; IRCCS San Raffaele Hospital, Milan, Italy, MIlan, Italy; ., Fundacio Puigvert, 16444, Urology, Barcelona, Catalunya, Spain; ., Fundacio Puigvert, 16444, Barcelona, Catalunya, Spain; ., Fundacio Puigvert, 16444, Barcelona, Catalunya, Spain; ., Fundacio Puigvert, 16444, Department of Urology, Barcelona, Catalunya, Spain., Fundacio Puigvert, 16444, Pathology, Barcelona, Catalunya, Spain; ., cartagena 340Barcelona, Spain, 08025; ., Fundacio Puigvert, 16444, Urology, Barcelona, Catalunya, Spain; .