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Endoscopic Treatment for Large Multifocal Upper Tract Urothelial Carcinoma

2020; Lippincott Williams & Wilkins; Volume: 205; Issue: 4 Linguagem: Inglês

10.1097/ju.0000000000001505

1527-3792

Asaf Shvero, Yasmin Abu‐Ghanem, Menahem Laufer, Zohar Dotan, Dorit E. Zilberman, Yoram Mor, Orith Portnoy, Eddie Fridmen, Harry Winkler, Nir Kleinmann,

Urological Disorders and Treatments

No AccessJournal of UrologyAdult Urology1 Apr 2021Endoscopic Treatment for Large Multifocal Upper Tract Urothelial CarcinomaThis article is commented on by the following:Editorial Comment Asaf Shvero, Yasmin Abu-Ghanem, Menahem Laufer, Zohar A. Dotan, Dorit E. Zilberman, Yoram Mor, Orith Portnoy, Eddie Fridmen, Harry Winkler, and Nir Kleinmann Asaf ShveroAsaf Shvero *Correspondence: Department of Urology, Sheba Medical Center, Ramat Gan, Israel5262000 telephone: +972-3-5302231; E-mail Address: [email protected] The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author , Yasmin Abu-GhanemYasmin Abu-Ghanem The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author , Menahem LauferMenahem Laufer The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author , Zohar A. DotanZohar A. Dotan The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author , Dorit E. ZilbermanDorit E. Zilberman The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author , Yoram MorYoram Mor The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author , Orith PortnoyOrith Portnoy The Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author , Eddie FridmenEddie Fridmen The Department of Pathology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author , Harry WinklerHarry Winkler The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author , and Nir KleinmannNir Kleinmann The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001505AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We reviewed the oncologic and surgical outcomes of endoscopic treatments for low grade upper tract urothelial carcinoma, and assessed the prognostic significance of tumor size, location and multifocality. Materials and Methods: We retrospectively reviewed all patients who underwent endoscopic treatment for low grade upper tract urothelial carcinoma at our institution between 2014 and 2019. Tumors were treated with a dual laser generator, which alternately produces holmium and neodymium lasers. A stringent ureteroscopic followup protocol was conducted. We looked for an association between outcome and tumor size, location or multifocality, and for predictive factors for time to local recurrence and progression. Results: The cohort included 59 patients (62 renal units), 27% of tumors were multifocal and 40% were >2 cm. The median followup time was 22 months (IQR 11–41), and the median number of ureteroscopies was 5.5 (4–9). Local recurrence was observed in 46 renal units (74.1%) at a median of 6.5 months after initial surgery. Four patients (6.4%) developed disease progression and were referred for radical surgery: 2 had pathological progression and 2 had a rapid and high volume local recurrence, and 1 later developed metastatic disease. The progression-free rate was 93.2%. Tumor location in kidney (p=0.03, HR 1.95) and multifocality (p=0.005, HR 3.25) significantly predicted time to local recurrence. No factor predicted time to progression. Conclusions: Ureteroscopic treatment of large, multifocal, low grade upper tract urothelial carcinoma is feasible, does not involve significant complications and has good short-term oncologic outcomes, with a 93.2% progression-free survival rate. Tumors located in the kidney and multifocality yielded shorter time to local recurrence but not progression. References 1. : Impact of tumour size on prognosis of upper urinary tract urothelial carcinoma after radical nephroureterectomy: a multi-institutional analysis of 795 cases. BJU Int 2016; 118: 902. 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Link, Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySmith J (2021) This Month in Adult UrologyJournal of Urology, VOL. 205, NO. 4, (951-952), Online publication date: 1-Apr-2021.Related articlesJournal of UrologyJan 21, 2021, 12:00:00 AMEditorial Comment Volume 205Issue 4April 2021Page: 1039-1046 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsureteroscopycarcinoma, transitional cellnephronsurologic surgical proceduresMetricsAuthor Information Asaf Shvero The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel *Correspondence: Department of Urology, Sheba Medical Center, Ramat Gan, Israel5262000 telephone: +972-3-5302231; E-mail Address: [email protected] More articles by this author Yasmin Abu-Ghanem The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author Menahem Laufer The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author Zohar A. Dotan The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author Dorit E. Zilberman The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author Yoram Mor The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author Orith Portnoy The Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author Eddie Fridmen The Department of Pathology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author Harry Winkler The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author Nir Kleinmann The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author Expand All Advertisement Loading ...