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Importance of long-term follow-up after endoscopic management for upper tract urothelial carcinoma and factors leading to surgical management

  • Urology - Original Paper
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Abstract

Purpose

Patients undergoing endoscopic management for upper tract urothelial carcinoma often progress to definitive therapy with radical nephroureterectomy. This study examined the rate of progression as well as risk factors for transitions in treatment over time.

Methods

Retrospective review at two institutions identified patients undergoing endoscopic management for upper tract urothelial carcinoma. Patients were assessed for progression to radical nephroureterectomy. Baseline characteristics were compared using Chi square analysis. Kaplan–Meier method analyzed the probability of patients not progressing to radical nephroureterectomy. Cox proportional hazards identified factors associated with progression to radical nephroureterectomy.

Results

Eighty-one patients had endoscopic management alone and 89 progressed to radical nephroureterectomy. The two groups had similar age, histories of bladder cancer, and Charlson comorbidity index. Positive urinary cytology, ureteroscopic visualization, and biopsy grade were higher in those progressing to RNU (p < 0.001). Hazard modeling demonstrated higher rates of progression to radical nephroureterectomy with positive biopsy (HR 11.8, 95% CI 2.4–59.5, p = 0.003) or visible lesion on ureteroscopy (HR 8.4, 95% CI 3.0–23.9, p < 0.001). Patients with a higher Charlson comorbidity index were less likely to have radical nephroureterectomy. On Kaplan–Meier modeling, the probability of not undergoing radical nephroureterectomy at 2 years and 5 years was 50% and 20%, respectively.

Conclusions

Patients who progress to radical nephroureterectomy after endoscopic management have fewer comorbid conditions and changes in disease status including visible lesions on ureteroscopy and positive biopsies. The high rate of progression to radical nephroureterectomy reinforces the need for long-term follow-up of these patients.

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Acknowledgements

Funding was provided in part by the Sidney Kimmel Center for Prostate and Urologic Disease.

Funding

K08DK097302-01A1, UL1 TR000448, R24 HS19455, KM1CA156708, P30 CA008748, Sidney Kimmel Center for Prostate and Urologic Disease.

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Authors and Affiliations

  1. Department of Urology, University of Pittsburgh, Kaufmann Medical Building, 3471 Fifth Ave, Suite 700, Pittsburgh, PA, 15213, USA

    Anand Mohapatra

  2. Division of Urologic Surgery, Department of Surgery, Washington University, St. Louis, MO, USA

    Seth A. Strope & Joel Vetter

  3. Department of Urology, St. Joseph Mercy Health System, Ann Arbor, MI, USA

    Nick Liu

  4. Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Andrew Winer

  5. Department of Surgery-Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Nicole E. Benfante & Jonathan A. Coleman

  6. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Jonathan A. Coleman

  7. Division of Urology, Department of Surgery, University of Missouri, Columbia, MO, USA

    Katie S. Murray

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  1. Anand Mohapatra
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  2. Seth A. Strope
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  3. Nick Liu
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  4. Andrew Winer
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  6. Jonathan A. Coleman
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  7. Joel Vetter
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Correspondence to Anand Mohapatra.

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Mohapatra, A., Strope, S.A., Liu, N. et al. Importance of long-term follow-up after endoscopic management for upper tract urothelial carcinoma and factors leading to surgical management. Int Urol Nephrol 52, 1465–1469 (2020). https://doi.org/10.1007/s11255-020-02439-5

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  • DOI: https://doi.org/10.1007/s11255-020-02439-5

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