Ureteroscopic Management of Large ≥2 cm Upper Tract Urothelial Carcinoma

A Comprehensive 23-Year Experience

Kymora B. Scotland, Nir Kleinmann, Dillon Cason, Logan Hubbard, Ryuta Tanimoto, Kelly A. Healy, Scott G. Hubosky, Demetrius H. Bagley

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To evaluate the effectiveness of ureteroscopy (URS) with laser ablation as an alternative treatment for upper tract urothelial carcinoma (UTUC) lesions larger than 2 cm. Traditionally, patients with large UTUC are treated with radical nephroureterectomy (RNU). However, in patients with pre-existing renal disease, a solitary kidney, or those who decline RNU, management of UTUC may prove challenging Methods: An institutional database review identified 80 patients with biopsy proven low-grade UTUC who had at least one lesion larger than 2 cm. We collected clinical data including demographics, operative parameters, and pathologic features. Follow-up for all patients was standardized and included cystoscopy and URS every 3 months until clear, every 6 months through the fifth year, and yearly thereafter. We calculated rates of recurrence, progression, and overall survival. Results: In total, 86 unique lesions ≥2cm were identified in the 80 qualifying patients; mean tumor size was 3.04 cm. Median follow-up was 43.6 months. During follow-up of patients treated curatively, 90.5% of tumors had ipsilateral recurrence and 31.7% progressed in grade at a median of 26.3 months. RNU was performed in 16 patients (20%); mean time to surgery was 23.2 months. Overall survival was 75%, and cancer specific survival was 84% at 5-year follow-up. Conclusion: Under strict surveillance, ureteroscopic management of large (≥ 2cm) UTUC lesions is a viable treatment alternative to RNU. While recurrence is common, URS can potentially preserve renal units in patients with large lesions.

Original languageEnglish
JournalUrology
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Carcinoma
Ureteroscopy
Kidney
Recurrence
Survival
Neoplasms
Cystoscopy
Preexisting Condition Coverage
Laser Therapy
Demography
Databases
Biopsy
Therapeutics

ASJC Scopus subject areas

  • Urology

Cite this

Ureteroscopic Management of Large ≥2 cm Upper Tract Urothelial Carcinoma : A Comprehensive 23-Year Experience. / Scotland, Kymora B.; Kleinmann, Nir; Cason, Dillon; Hubbard, Logan; Tanimoto, Ryuta; Healy, Kelly A.; Hubosky, Scott G.; Bagley, Demetrius H.

In: Urology, 01.01.2018.

Research output: Contribution to journalArticle

Scotland, Kymora B. ; Kleinmann, Nir ; Cason, Dillon ; Hubbard, Logan ; Tanimoto, Ryuta ; Healy, Kelly A. ; Hubosky, Scott G. ; Bagley, Demetrius H. / Ureteroscopic Management of Large ≥2 cm Upper Tract Urothelial Carcinoma : A Comprehensive 23-Year Experience. In: Urology. 2018.
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abstract = "Objective: To evaluate the effectiveness of ureteroscopy (URS) with laser ablation as an alternative treatment for upper tract urothelial carcinoma (UTUC) lesions larger than 2 cm. Traditionally, patients with large UTUC are treated with radical nephroureterectomy (RNU). However, in patients with pre-existing renal disease, a solitary kidney, or those who decline RNU, management of UTUC may prove challenging Methods: An institutional database review identified 80 patients with biopsy proven low-grade UTUC who had at least one lesion larger than 2 cm. We collected clinical data including demographics, operative parameters, and pathologic features. Follow-up for all patients was standardized and included cystoscopy and URS every 3 months until clear, every 6 months through the fifth year, and yearly thereafter. We calculated rates of recurrence, progression, and overall survival. Results: In total, 86 unique lesions ≥2cm were identified in the 80 qualifying patients; mean tumor size was 3.04 cm. Median follow-up was 43.6 months. During follow-up of patients treated curatively, 90.5{\%} of tumors had ipsilateral recurrence and 31.7{\%} progressed in grade at a median of 26.3 months. RNU was performed in 16 patients (20{\%}); mean time to surgery was 23.2 months. Overall survival was 75{\%}, and cancer specific survival was 84{\%} at 5-year follow-up. Conclusion: Under strict surveillance, ureteroscopic management of large (≥ 2cm) UTUC lesions is a viable treatment alternative to RNU. While recurrence is common, URS can potentially preserve renal units in patients with large lesions.",
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