Endoscopic kidney-sparing surgery outcomes of high-grade upper tract urothelial cancer

Endoscopic kidney-sparing surgery (eKSS) for high-grade (HG) upper tract urothelial carcinoma (UTUC) is still matter of debate. We quantified the oncological outcomes, namely UTUC recurrence-free survival (RFS), UTUC progression-free survival (PFS), radical nephroureterectomy (RNU)-free survival, bladder recurrence-free survival (BCAR), cancer-specific mortality (CSM) and other-cause mortality (OCM), of these patients.

We relied on a multicentre retrospective database (UTUC registry) including 358 UTUC patients who underwent eKSS with curative intent between 2010 and 2021. Kaplan-Meyer plots depicted the following oncological outcomes: UTUC RFS, UTUC-PFS, RNU-free survival, BCAR, CSM and OCM.

Based on a median follow-up of 27 months, 72 HG UTUC patients were identified. Of those, 50 (69%) harbored an elective indication for conservative management. According to tumor characteristics, 43 (60%) harbored a tumor size ≥2 cm, 30 (42%) UTUC patients exhibited positive cytology, and 25 (35%) were multifocal. According to their urothelial tumor history, 25 (35%) presented previous BCA, 22 (31%) synchronous BCA, 15 (21%) previous UTUC, and 4 (5.6%) previous RC. The 2-years RNU-free survival, UTUC PFS, and BCAR-free survival rates were 64%, 79%, and 84%, respectively. The 2-year CSM rate was 9% and 2-year OCM rate was 20%.

Within the current study, eKSS might be an option to delay radical surgery in patients with high grade apparently noninvasive disease with increased comorbidities and decreased life expectancy. Specifically, this approach may represent an option in selected patients with HG UTUC, where OCM almost doubled CSM.