OBJECTIVE: To compare overall and cancer-specific outcomes between upper tract urothelial carcinoma (UTUC) patients managed with either radical nephroureterectomy (NUx) or nephron-sparing measures (NSM) using a large population-based dataset.
MATERIALS AND METHODS: Using Surveillance, Epidemiology, and End Results (SEER) data, patients diagnosed with low or moderate grade, localized noninvasive UTUC were stratified into two groups: those treated through NUx or NSM (observation, endoscopic ablation, or segmental ureterectomy). Cancer and non-cancer specific mortality rates were determined using cumulative incidence estimators. Adjusting for clinical and pathologic characteristics, the associations between surgical type, overall, and cancer-specific mortality (CSM) were tested using Cox regressions and Fine and Gray regressions, respectively.
RESULTS: Of 1,227 patients (mean age 70.2±11.0yrs, 63.2% male) meeting criteria, 907 (73.9%) and 320 (26.1%) patients underwent NUx and NSM for low or moderate grade, low stage UTUC from 1992-2008. Patients undergoing NSM were older (mean age 71.6 vs. 69.7yrs, p< 0.01) with a greater proportion of well-differentiated tumors (26.3% vs. 18.0%, p=0.001). While there were differences in other cause mortality observed between groups (p< 0.01), CSM trends were equivalent. After adjustment, NUx treatment was associated with improved non-cancer cause survival (HR=0.78, CI [0.64-0.94]) while no association with CSM was demonstrable (HR=0.89, CI [0.63-1.26]).
CONCLUSIONS: Patients with low or moderate grade, low stage UTUC managed through NSM are older and are more likely to die of other causes, but they have similar CSM rates to those patients managed with NUx. These data may be useful when counseling UTUC patients with significant competing comorbidities.
Written by:
Simhan J, Smaldone MC, Egleston BL, Canter D, Sterious SN, Corcoran AT, Ginzburg S, Uzzo RG, Kutikov A. Are you the author?
Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA, 19111.
Reference: BJU Int. 2013 Jul 2. Epub ahead of print.
doi: 10.1111/bju.12341
PubMed Abstract
PMID: 24053485
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