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MP70-01 EXTIRPATIVE TREATMENT OF UPPER URINARY TRACT UROTHELIAL CARCINOMA: A 15-YEAR COMPREHENSIVE REVIEW

2015; Lippincott Williams & Wilkins; Volume: 193; Issue: 4S Linguagem: Inglês

10.1016/j.juro.2015.02.2526

1527-3792

Lynn J. Paik, Michael Grasso, Bobby Alexander, Andrew I. Fishman,

Urological Disorders and Treatments

You have accessJournal of UrologyKidney Cancer: Surgical Therapy V1 Apr 2015MP70-01 EXTIRPATIVE TREATMENT OF UPPER URINARY TRACT UROTHELIAL CARCINOMA: A 15-YEAR COMPREHENSIVE REVIEW Lynn Paik, Michael Grasso, Bobby Alexander, and Andrew Fishman Lynn PaikLynn Paik More articles by this author , Michael GrassoMichael Grasso More articles by this author , Bobby AlexanderBobby Alexander More articles by this author , and Andrew FishmanAndrew Fishman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2526AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Extirpative treatment of Upper Urinary Tract Urothelial Carcinoma (UTUC) has long been the standard of care regardless of tumor grade. We herein stratify oncologic outcomes based on tumor grade with implications for the role of systemic chemotherapy. We present long-term oncologic outcomes of all patients treated with nephroureterectomy (NU) for UTUC over a 15 year time period. METHODS All patients (N=80) were treated by a single surgeon with extirpative surgery for UTUC as a primary treatment. The majority (90%) underwent laparoscopic NU via a retroperitoneal approach, with transurethral incision of the ureteric orifice and then open bladder-cuff excision through a Gibson incision. The open surgical approach was used in 6 (7.5%) cases and distal/ segmental ureterectomy only was used sparingly (2.5%). Data was prospectively collected and concurrent outpatient follow up data were retrospectively reviewed. Statistical analysis was performed using Kaplan Meier methodology to calculate overall survival (OS), cancer specific survival (CSS), and metastasis-free survival (MFS). RESULTS The mean age of patients was 72.5 (range 46-90), 50 male (62.5%) and mean Charlston Comorbidity Index of 5.1 (range 0-13). Mean follow-up time was 30.4 months (range 1-185.3) with median overall survival 109.2 months. Twenty-three patients (28.8%) with low grade tumors, treated with primary NU, had 2-, 5-, and 10-year OS of 100, 88, 73%. In contrast, 57 (71.3%) with high grade tumors had a lower 2-, 5-, and 10-year OS of 83, 68, 0%. Table 1 summarizes the oncologic outcomes based on histologic grade. Lymph node positive disease portends a particularly grim prognosis with 2- and 5-year OS and CSS of 24 and 0% respectively CONCLUSIONS Grade is a significant predictor of OS, CSS, and MFS in patients treated with nephroureterectomy for UTUC. Extirpative therapy was found to result in relatively poor long-term CSS in patients with high grade disease, underscoring the need for adjuvant or neoadjuvant therapies. Table 1. OS CSS MFS 2-year, % 5-year, % 10-year, % 2-year, % 5-year, % 10-year, % 2-year, % 5-year, % 10-year, % Low grade 100 88 73 100 93 93 95 95 95 High grade 83 68 0 88 72 58 72 61 51 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e875 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lynn Paik More articles by this author Michael Grasso More articles by this author Bobby Alexander More articles by this author Andrew Fishman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...