Presented by: Hen Hendel MD
Rabin Medical Center

Introduction

Endoscopic ablation is currently the preferred treatment for low-grade, favorable upper urinary tract tumors (UTUC) and may be offered to patients with unfavorable low-grade UTUC. In this study, we analyzed the oncological outcomes of endoscopic treatments compared to nephroureterectomy (NU) and evaluated the favorable and unfavorable low-risk subgroups within the endoscopic group.

Materials

We conducted a retrospective review of medical records from two institutions, covering the periods 1998-2022 and 1996-2021 for endoscopic treatments and NU, respectively, focusing exclusively on patients with low-grade disease. Demographic information, tumor characteristics, and surgical follow-up data, including metastatic progression and overall survival, were collected. Kaplan-Meier curves and the Log rank test were used to compare the outcomes between the two treatment modalities.

Results

,

The study included a total of 109 patients who underwent endoscopic treatment and 56 who underwent NU. Among them, 45 patients (27.2%) were women, with a median age of 72 (IQR 61-80) and 68 (63-74) in the endoscopic and radical resection groups, respectively (p=0.623). The median tumor size was 14 mm (10-20) and 25.5 mm (20-34.15) in the endoscopic treatment and NU groups, respectively (p<0.001).

The median follow-up duration was 29 months (12.75-57.25) for the endoscopic group and 55 months (24-93) for the NU group. Metastatic progression was observed in 3 patients (5.3%) in the NU group compared to 5 patients (4.5%) in the endoscopic group, with no statistically significant difference (p=0.891). The median overall survival was 178 and 143 months for the endoscopic and NU groups, respectively, with no statistically significant difference (p=0.382). Within the endoscopic treatment group, a subgroup analysis revealed no statistically significant differences in terms of all-cause mortality, metastatic disease, and eventual NU between the favorable and unfavorable low-risk subgroups. However, the unfavorable group was associated with a higher number of ureteroscopies.

Conclusion

The mid-term oncological outcomes of NU and endoscopic ablation for low-grade UTUC favorable and unfavorable groups are similar.

Funding

None

Co-Authors

Shayel Bercovich, MD
Rabin Medical Center

Asaf Shvero, MD
sheba medical center

Nir Kleinman, MD
Sheba medical center

David Lifshitz, MD
Rabin Medical Center