Survival Comparison between Endoscopic and Surgical Management for Patients with Upper Tract Urothelial Cancer: A Matched Propensity Score Analysis Using SEER-Medicare Data

To determine survival differences among patients receiving endoscopic versus surgical management for upper tract urothelial carcinoma (UTUC).

Using SEER-Medicare data, patients diagnosed with non-muscle invasive, low grade UTUC as their first cancer diagnosis between 2004 and 2009 were identified. Receipt of endoscopic and surgical interventions were assessed, and patients were separated into surgical or endoscopic management cohorts. Two-to-one propensity score analysis was performed to control for baseline characteristics between groups.

The endoscopic management (n=151) and matched surgical management (n=302) groups demonstrated no significant differences in age, gender, race, marital status, Charlson comorbidity index (CCI), or year of diagnosis. Endoscopic management was an independent and significant predictor of all-cause and cancer-specific mortality (HR 1.6 for OS, HR 2.1 for CSS). Kaplan-Meier estimated survival was significantly lower for endoscopic management, with both OS and CSS curves diverging at approximately 24-36 months. A subset of patients initially receiving endoscopic management went on to receive surgical intervention (80/151 = 53%) at a median of 8.8 months from diagnosis. For these patients, Kaplan-Meier estimated CSS was not significantly different from those who continued with only endoscopic management, and remained significantly lower than patients who received upfront surgery.

Although initial survival outcomes (first 24 months) are similar for endoscopic and surgical management of non-muscle invasive, low grade UTUC, both CSS and OS is significantly inferior for the endoscopic management group in the longer term. Furthermore, transition from initial endoscopic management to surgical intervention appears to have limited impact on survival.

Urology. 2016 May 24 [Epub ahead of print]

Goutham Vemana, Eric H Kim, Sam B Bhayani, Joel M Vetter, Seth A Strope

Department of Surgery, Division of Urology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA., Department of Surgery, Division of Urology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA., Department of Surgery, Division of Urology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA., Department of Surgery, Division of Urology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA., Department of Surgery, Division of Urology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA. Electronic address: .