OncologySurvival Comparison Between Endoscopic and Surgical Management for Patients With Upper Tract Urothelial Cancer: A Matched Propensity Score Analysis Using Surveillance, Epidemiology and End Results-Medicare Data
Section snippets
Identification of Overall Cohort
We assessed SEER-Medicare data for patients diagnosed with nonmuscle-invasive (American Joint Committee on Cancer stage Ta, Tis, T1),11 low-grade UTUC based on diagnosis codes between years 2004 and 2009 with follow-up data available through 2011. We excluded patients with nodal or metastatic disease based on the SEER historical staging system variable. Information on recurrence is not available in the SEER data. Per the SEER grading guidelines,12 transitional cell carcinoma is classified by a
Results
Table 1 summarizes the baseline clinical information for the patients who received endoscopic management and the matched cohort of patients who received surgical management. As expected, based on the matching algorithm, there were no significant differences in age, gender, race, marital status, Charlson comorbidity index, or year of diagnosis between the 2 groups. In the cohort, 83% of all patients who had definitive surgery had final pathologic stage of T1 or less. Among patients with
Comments
Using propensity score analysis to control for baseline differences, our study aimed to identify survival differences between endoscopic and surgical management for patients diagnosed with nonmuscle-invasive, low-grade UTUC as their first malignancy. We found that patients receiving upfront surgical management had significantly improved OS and CSS, and accordingly endoscopic management was an independent predictor of all-cause and cancer-specific mortality. The significant improvement in OS and
Conclusion
For nonmuscle-invasive, low-grade UTUC, endoscopic management provides similar early (first 24 months) OS and CSS to upfront surgical management. However, after this period of time, survival curves diverge with significantly inferior OS and CSS for patients who received endoscopic management. For patients who eventually underwent surgical intervention after initial endoscopic management, CSS remains significantly inferior to those who received upfront surgical management, and CSS remains
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Oncologic and Safety Outcomes for Endoscopic Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: An Updated Systematic Review and Meta-analysis
2023, European Urology FocusCitation Excerpt :Detailed search terms, the inclusion and exclusion criteria, and the statistical analyses are described in full in the Supplementary material. Overall, 13 studies [7–19] were included in the review, of which five were eligible for meta-analysis. The study characteristics are shown in Table 1.
Upper urothelial tract high-grade carcinoma: comparison of urine cytology and DNA methylation analysis in urinary samples
2021, Human PathologyCitation Excerpt :Low-risk cancers can be effectively treated with kidney sparing endoscopic approaches, but they could need stringent surveillance as second look or frequent ureter-renoscopy [7]. Nevertheless, a risk of disease progression remains with endoscopic management due to the suboptimal performance of imaging and biopsy for risk stratification and tumor biology [8]. For all these reasons, true grade identification and risk classification are the key points in therapeutic planning.
European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update
2021, European UrologyCitation Excerpt :The patient should be informed of the need and be willing to comply with an early second-look URS [136] and stringent surveillance; complete tumour resection or destruction is necessary [136]. Nevertheless, a risk of disease progression remains with endoscopic management due to the suboptimal performance of imaging and biopsy for risk stratification and tumour biology [137]. Percutaneous management can be considered for low-risk UTUC in the renal pelvis [134,138] (LE: 3).
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: This study was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences of the National Institutes of Health. Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality. Barnes-Jewish Hospital Foundation/ICTS Clinical and Translational Science Research award (UL1 RR024992); Washington University KL2 Career Development Awards Program (KL2 TR000450); and the National Institute of Diabetes and Digestive and Kidney Diseases Clinical Investigator Award (1K08DK097302-01A1).