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Conservative management in selected patients with upper tract urothelial carcinoma compares favourably with early radical surgery
Author(s) -
Lucas Steven M.,
Svatek Robert S.,
Olgin Guadencio,
Arriaga Yull,
Kabbani Wareef,
Sagalowsky Arthur I.,
Lotan Yair
Publication year - 2008
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2008.07535.x
Subject(s) - medicine , conservative management , conservative treatment , surgery , stage (stratigraphy) , kidney disease , endoscopy , radical surgery , urology , cancer , paleontology , biology
OBJECTIVE To compare the outcomes of patients treated for upper tract urothelial carcinoma with either immediate nephroureterectomy (NU) or initial endoscopic management. PATIENTS AND METHODS The treatments of 108 patients (120 renal units) at the authors’ institution were retrospectively reviewed and divided into two groups, i.e. those who received immediate NU and those who had conservative initial therapy, which included renal units solely treated with endoscopy with or without delayed NU. Overall and disease‐specific survival (DSS) were compared between the treatment groups. RESULTS There were 48 low‐grade tumours, of which 27 (56%) were managed conservatively and 21 (44%) by immediate NU. Seven patients treated conservatively had stage or grade progression and had delayed NU. The mean ( sd ) DSS at 5 years in patients with low‐grade disease was equally good for conservative treatment and immediate NU, at 86.2 (9.1)% vs 87.4 (8.4)% ( P = 0.909). There were 68 high‐grade tumours, of which 12 (18%) patients had conservative management and 56 (82%) had immediate NU. Among the former, seven of 12 had a solitary kidney and three had bilateral disease. In patients managed endoscopically, four of 30 (13%) required delayed NU. The DSS for the conservative and immediate NU groups were 68.6 (18.6)% vs 75.0 (8.1)% ( P = 0.528). CONCLUSION Management with a conservative approach in selected patients provides comparable outcomes to immediate NU in patients with low‐grade disease.