Washington, DC (UroToday.com) Radical nephroureterectomy with bladder cuff excision is the gold standard treatment for upper tract urothelial carcinoma (UTUC). For select patients, endoscopic management is another acceptable treatment option. In this study, Kim and colleagues from Washington University in St Louis sought to determine differences in OS and CSS between patients who receive endoscopic versus surgical management of UTUC. Using SEER-
Medicare linked data, patients with low grade, localized disease between 2004-2009 were identified (n=1093). Nearest neighbor (2:1) propensity score matching based on age, race, gender, martial status, year of diagnosis, and Charlson comorbidity index (CCI) was performed. A total of 302 patients undergoing surgical management and 151 patients undergoing endoscopic management were included. Endoscopic management was an independent predictor of overall mortality and cancer specific mortality (HR 1.6, CI 1.3-2.2 and HR 2.1, CI 1.0-4.1, respectively). Cancer-specific survival was reduced for patients receiving delayed surgical intervention after initial endoscopic management compared to upfront surgery. The authors concluded that cancer-specific mortality and overall mortality outcomes were inferior with endoscopic management relative to surgery. This may be due to initial understaging in patients treated endoscopically. Randomized trials are needed to confirm these findings.
Dr. Eric H. Kim, MD
Washington University School of Medicine, St. Louis, Missouri