Endoscopic Management Beneficial But Costly for Low-Grade Upper Tract Urothelial Carcinoma

Patients with low-grade upper tract urothelial carcinoma who underwent endoscopic management had an 81% chance of 5-year metastasis-free survival and an 83% chance of preserving their kidney, but treatment costs were higher compared to radical management. Researchers published their findings in Urology.

Researchers compared procedure burden as well as oncologic, surgical, and renal-function outcomes among patients with low-grade upper tract urothelial carcinoma referred for either kidney-sparing endoscopic management or radical management.

Of the patients included in the retrospective study, 24 were treated with endoscopic management and 37 with radical management. Except for tumor size, surgical and oncologic risk factors were similar across patients, and the mean follow-up was 4.9 ± 3.4 years.

The overall survival rate after 5 years was 85% with endoscopic management and 84% with radical management (P = .707). According to study authors, metastasis-free and cancer-specific survival were also comparable (P = .994, P = .960).

Average glomerular filtration rates were 58.7 ± 21.5 and 49.2 ± 22.1 mL/min/1.73 m², respectively (P = .12) at the end of follow-up.

Local recurrences were observed in 92% of patients managed endoscopically, with an average of 3.2 recurrences per patient. Seventeen percent of patients underwent salvage radical nephroureterectomy.

Endoscopic management resulted in higher procedure burden, with 6.5 ± 4.4 operations and 344 ± 272 minutes under anesthesia, compared to 1.9 ± 0.4 operations (P <.0001) and 213 ± 84 minutes under anesthesia (P = .031) for the group treated with radical management.

Compared to radical management, endoscopic management was associated with higher costs for both private and public insurance plans.

“Our findings support endoscopic management for low-grade upper tract urothelial carcinoma as a valid option from oncological aspects but highlight the associated costs,” concluded researchers.

Reference:
Shenhar C, Veredgorn Y, Bulis S, et al. Endoscopic management of low-grade upper tract urothelial carcinoma: characterizing the long-term burden of care in comparison to radical nephroureterectomy. Urology. 2022;159:152-159. doi:10.1016/j.urology.2021.06.053