Category: Clinical Oncology: Outcomes & Complications

MP18-10 - Conservative treatment of urothelial carcinoma of the upper tract: should we push the indications?

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

Patients with urothelial carcinoma of the upper tract (UTUC) can be eligible for kidney-sparing surgery in case of low risk UTUC defined by unifocal disease, tumor size < 1 cm, low-grade cytology, low-grade biopsy, and non-invasive aspect on CT-urography. However, some studies reported conservative management of supracentimetric and/or multifocal, low grade and non-invasive UTUC. In this study, we aimed to compare the influence of tumor size (infracentimetric versus supracentimetric disease) and focality (unifocal versus multifocal disease) on survival rates after conservative treatment among patients with low grade, non-invasive UTUC.


Methods :

Between December 2003 and December 2016, 90 patients were included in this study. Group 1 was defined by low-grade, non-invasive, infracentimetric and unifocal UTUC. Group 2 was defined by low-grade, non-invasive, supracentimetric and/or multifocal UTUC. All the patients underwent conservative treatment. Group 1 and group 2 included 31 and 59 patients, respectively. We assessed recurrence-free survival (RFS), progression-free survival (PFS) and overall survival (OS). Survival data were calculated using Kaplan-Meier analysis. All tests were bilateral and a p-value <0.05 was considered as statistically significant.


Results :

Median length of follow-up was 52.0 months. The RFS at 1 year, 2 years and 5 years were 81.1%, 76.1% and 58.1% for group 1 and 58.8%, 51.1% and 44.5% for group 2, with no statistically significant difference (p = 0.160) (Figure 1a). The PFS at 1 year, 2 years and 5 years were constantly 75.0% for group 1 and 89.0%, 87.0% and 79.1% for group 2, with no statistically significant difference (p = 0.118) (Figure 1b). The OS at 1 year, 2 years and 5 years were constantly 93.5% for group 1 and 98.2%, 96.1% and 77.4% for group 2 with no statistically significant difference (p = 0.634).


Conclusions :

Survival rates of kidney-sparing management seem to be equivalent when comparing low risk UTUC to supracentimetric and/or multifocal UTUC. However, these results should be interpreted with caution due to relatively small population sizes and low occurrence of events that make statistical analysis unreliable. Additional studies are needed to conclude that these two populations are equivalent for kidney-sparing management.

Etienne X. Keller

Fellow of the ES
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France

Mattieu Haddad

Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France

Vincent De Coninck

Urologist
AZ Klina
Brasschaat, Antwerpen, Belgium

Vincent De Coninck graduated as a medical doctor from the Free University of Brussels, Belgium (VUB) in 2011. He became a certified urologist in 2017 after a training at the University Hospital of Brussels (Prof. Dr. Dirk Michielsen) and OLV Aalst (Prof. Dr. Alex Mottrie), where he developed a special interest in the minimal invasive treatment of benign and malignant pathologies. In the same year, he became Fellow of the European Board of Urology.
In 2018, he completed a one-year fellowship program of the Endourological Society in Paris, France under the supervision of Prof. Dr. Olivier Traxer. During that fellowship, he also obtained a diploma in urolithiasis, organized by Dr. Michel Daudon at the Sorbonne University in Paris, France. Afterwards, he was trained in HoLEP by Dr. Karin Lehrich in Berlin, Germany.
Currently, he is completing a three-month fellowship under the supervision of Dr. Guido Giusti in Milan, Italy. In December 2018, he will start working as an endourologist in AZ Klina, Brasschaat, Belgium. He will focus on the medical and surgical treatment of kidney stones and benign prostatic obstruction (HoLEP) and he will continue publishing articles relating to the management of patients with renal stone disease.

Maria Rodriguez-Monsalve Herrero

Urologist
University Hospital Puerta de Hierro, Majadahonda.
Majadahonda, Madrid, Spain

Steeve S. Doizi

Urologist
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France

Olivier O. Traxer

Professor
Sorbonne Universite, GRC n020 Lithiase Renale, AP-HP, Hospital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France