Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-muscle Invasive Bladder Cancer Guidelines Panel

Seisen, Thomas; Peyronnet, B.; Domínguez-Escrig, José; Bruins, Harman Max; Yuan, Yuhong; Babjuk, Marko; Böhle, Andreas; Burger, Maximilian; Compérat, Éva; Cowan, Nigel C.; Kaasinen, Eero; Palou, Joan; Rhijn, Bas W.G. van; Sylvester, Richard; Zigeuner, Richard; Shariat, Shahrokh F.; Rouprêt, Morgan

doi:10.1016/j.eururo.2016.07.014

Cited by 259 publications

(196 citation statements)

References 41 publications

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“…In addition, other treatment options may be considered for patients with lowgrade tumors and a risk of postoperative CKD. Seisen et al [27] suggested similar survival rates between post-kidney sparing surgery and RN only for patients with lowgrade and noninvasive UTUC, by endoscopic surgery.…”

Section: Discussionmentioning

confidence: 96%

Comparison of Renal Function after Radical Surgery for Upper Tract Urothelial Carcinoma versus Renal Cell Carcinoma: Propensity Score Matching

Tae

Kwak

et al. 2018

Urol Int

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Objectives: To compare renal function after radical nephrectomy for renal cell carcinoma (RCC) and for upper tract urothelial carcinoma (UTUC). Method: Data from 1,236 patients with RCC or UTUC treated surgically from 2000 to 2013 were enrolled. The estimated glomerular filtration rate (eGFR) was calculated preoperatively and postoperatively at 12, 24, 36, 48, and 60 months. A multivariate logistic regression was used to determine independent factors for a decrease in eGFR to < 60 mL/min/1.73 m² and end-stage renal disease. Result: After propensity score matching, a total of 554 patients were included. During follow-up for 5 years, there was statistically significant difference in eGFR between 2 groups. And there was a statistically significant difference in the number of patients developing impaired renal function between the 2 groups (UTUC 73.3 vs. RCC 66.1%, p = 0.039). Multivariate analysis showed that old age (OR 3.957, p < 0.001), UTUC (OR 1.838, p = 0.006), BMI (OR 2.463, p = 0.001) and a baseline eGFR (OR 0.976, p = 0.001) were independent risk factors for postoperative impaired renal function. Conclusion: Patients with UTUC had worse baseline eGFR, old age, comorbidities than RCC patients. Even after adjusting by PS matching, UTUC patients had lower postoperative eGFR and higher rates of CKD development than RCC patients.

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Section: Discussionmentioning

confidence: 96%

Comparison of Renal Function after Radical Surgery for Upper Tract Urothelial Carcinoma versus Renal Cell Carcinoma: Propensity Score Matching

Tae

Kwak

et al. 2018

Urol Int

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“…If a patient with a UTUC fulfills the criteria for low‐risk stratification (Table ), KSS avoids the morbidity associated with radical surgery without compromising oncological outcomes and kidney function . In low‐risk cancers, the survival rate of patients who undergo KSS might be similar to that in patients who undergo RNU …”

Section: Treatmentmentioning

confidence: 99%

“…Adequate margins should be preserved when carrying out segmental ureteral resection, and these could provide adequate pathological specimens for staging and grading. Lymphadenectomy can also be carried out during segmental ureteral resection …”

Section: Treatmentmentioning

confidence: 99%

Recent advances in upper tract urothelial carcinomas: From bench to clinics

2018

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Urothelial carcinoma in the upper tract is rare and often discussed separately. Many established risk factors were identified for the disease, including genetic and external risk factors. Radiographic survey, endoscopic examination and urine cytology remained the most important diagnostic modalities. In localized upper tract urothelial carcinomas, radical nephroureterectomy with bladder cuff excision are the gold standard for large, high‐grade and suspected invasive tumors of the renal pelvis and proximal ureter, whereas kidney‐sparing surgeries should be considered in patients with low‐risk disease. Advances in technology have given endoscopic surgery an important role, not only in diagnosis, but also in treatment. Although platinum‐based combination chemotherapy is efficacious in advanced or metastatic disease, current established chemotherapy regimens are toxic and lack a sustained response. Immune checkpoint inhibitors have led to a new era of treatment for advanced or metastatic urothelial carcinomas. The remarkable results achieved thus far show that immunotherapy will likely be the future treatment paradigm. The combination of immune checkpoint inhibitors and other agents is another inspiring avenue to explore that could benefit even more patients. With respect to the high incidence rate and different clinical appearance of upper tract urothelial carcinomas in Taiwan, a possible correlation exists between exposure to certain external risk factors, such as arsenic in drinking water and aristolochic acid in Chinese herbal medicine. As more gene sequencing differences between upper tract urothelial carcinomas and various disease causes are detailed, this has warranted the era of individualized screening and treatment for the disease.

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“…23 On the other hand, the decrease of glomerular filtration rate following RNU and therefore the risk of developing complications such as chronic kidney disease, may affect eligibility for adjuvant cisplatin-based therapies, particularly in elderly patients. 4 Furthermore, if we bear in mind that salvage RNU of the recurrences after conservative treatment provides comparable outcomes to immediate RNU in patients with lowgrade disease, [24][25][26] conservative treatment becomes a safe and a feasible option in selected cases.…”

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confidence: 99%

Conservative treatment of upper urinary tract carcinoma: Long-term results

Andrada

García

Fúnez

et al. 2017

CUAJ

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Introduction: We sought to assess the long-term results of conservative treatment for upper urinary tract carcinoma (UUTC) with regard to tumour recurrence and preservation of renal unit. Methods: From October 1987 to January 2014, 65 patients (median age 68 years) were diagnosed with UUTC and underwent endoscopic and open surgical techniques. Thirteen patients had bilateral disease and one had a single kidney. The primary approach was endoscopic in 37 reno-ureteral units (20 percutaneous resections, 17 ureteroscopies ). Open surgery was performed in 19 cases. A total of 20 patients received mitomycin C. Results: Superficial stage pTa or T1 was noted in 37 patients, infiltrating stage pT2 and pT3 in seven and inverted papilloma in one. The stage of the tumour was impossible to classify in 20. With a median followup of 75.12 months (interquartile range [IQR] 144.71-17.41), the kidney preservation, recurrence, specific survival, and global survival rates were 78.5% (51/65), 40.0% (26/65), 92.3% (60/65), and 69.2% (45/65), respectively. From the patients who had recurrence, 15 were salvaged with radical nephroureterectomy (RNU). The bladder tumour recurrence rate after the surgery was 30.76% (20/65). At the end of the followup, five patients had died of UUTC progression and 16 from other causes. Postoperative complications included one case of fistula, one case of stricture, and one case of nephrectomy due to bleeding. Conclusions: In selected cases, conservative management is a safe and feasible alternative to RNU, with the advantage of renal unit preservation. IntroductionUpper urinary tract carcinoma (UUTC) is uncommon and accounts for 5-10% of all urothelial carcinomas.1,2 Radical nephroureterectomy (RNU) with excision of the bladder cuff is the gold standard treatment for localized disease, regardless of the location of the tumour in the upper urinary tract.An interest in the conservative surgery, including endoscopic ablation and segmental resection, has emerged in recent years as an alternative for patients with UUTC and renal insufficiency, solitary functional kidney, comorbidities, or bilateral tumour, accounting for approximately 2-5% of UUTC patients. 3The elective cases for nephron-sparing surgery are considered in patients with low-grade, low-stage, unifocal, small tumours. In addition, the patient has to accept close followup because of the risk of recurrence, which is the main disadvantage of this treatment. 4 After RNU, the presence of a solitary kidney can lead to a renal insufficiency stage, which is associated with an increase in cardiovascular events and, therefore, in overall mortality. 4 It is well-documented that glomerular filtration rate decreases after RNU, with a mean of 24%, according to the outcomes of a recent multicentre analysis by Kaag et al. 5 These changes in renal function may affect eligibility for adjuvant cisplatin based-therapy. 5 Moreover, multifocal recurrence of UUTC in the contralateral side has renewed the interest in conservative treatment in elective cases. F...

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Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-muscle Invasive Bladder Cancer Guidelines Panel

Cited by 259 publications

References 41 publications

Comparison of Renal Function after Radical Surgery for Upper Tract Urothelial Carcinoma versus Renal Cell Carcinoma: Propensity Score Matching

Comparison of Renal Function after Radical Surgery for Upper Tract Urothelial Carcinoma versus Renal Cell Carcinoma: Propensity Score Matching

Recent advances in upper tract urothelial carcinomas: From bench to clinics

Conservative treatment of upper urinary tract carcinoma: Long-term results

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