Category: Clinical Oncology: Outcomes & Complications

MP30-19 - Importance of Long-Term Follow-Up After Endoscopic Management for Upper Tract Urothelial Carcinoma and Factors Leading to Surgical Management

Sun, Sep 23
2:00 PM - 4:00 PM

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


Methods :

Retrospective review at 2 institutions identified patients undergoing endoscopic management for upper tract urothelial carcinoma. Patients were assessed for progression to RNU. Baseline characteristics were compared using Chi-Square analysis. Kaplan Meier method estimated the probability of patients not progressing to RNU. Cox proportional hazards identified factors associated with progression to RNU.


Results : One hundred seventy patients were identified: 81 (48%) underwent endoscopic management alone, and 89 (52%) progressed to RNU. 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). (Table 1) Hazard modeling demonstrated higher rates of progression to RNU 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). (Table 2) Patients with a higher Charlson Comorbidity Index were less likely to have RNU. On Kaplan Meier modeling, the probability of not undergoing RNU at 2 years and 5 years were 50% and 20%, respectively. (Figure 1)


Conclusions : Patients who progress to RNU 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 RNU reinforces the need for long-term follow up these patients.

Anand Mohapatra

Resident Physician
Department of Urology, University of Pittsburgh
Pittsburgh, Pennsylvania

Seth Strope

Washington University, Department of Surgery-Division of Urologic Surgery
St. Louis, Missouri

Nick Liu

St. Joseph Mercy Health System, Department of Urology
Ann Arbor, Michigan

Andrew Winer

SUNY Downstate Medical Center, Department of Urology
Brooklyn, New York

Nicole Benfante

Memorial Sloan Kettering Cancer Center, Department of Surgery-Urology Service
New York, New York

Jonathan Coleman

Memorial Sloan Kettering Cancer Center, Department of Surgery-Urology Service
New York, New York

Joel Vetter

Statistician
Washington University in St. Louis
Saint Louis, Missouri

Katie Murray

University of Missouri, Department of Surgery-Division of Urology
Columbia, Missouri