Survival Outcomes for Patients with Localized Upper-Tract Urothelial Carcinoma Managed with Non-Definitive Treatment

To investigate the outcomes of patients with upper tract urothelial carcinoma (UTUC) with non-definitive therapy, which currently remains unknown.

We utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify individuals with a localized, histologically confirmed kidney/renal pelvis and ureteral urothelial carcinoma. Survival analysis using the Kaplan Meier method was performed. A competing risk model evaluated the cumulative incidence and predictors of cancer specific mortality (CSM).

We identified 633 (7.6%) individuals who did not receive surgery. These individuals were significantly older (median age: 81 vs. 71, p<0.001) than surgically managed patients. Median overall survival was significantly shorter compared to the surgical cohort (1.9 vs. 7.8 years, p<0.0001). The 3-year disease-specific survival (DSS) for patients without surgery was significantly lower compared to those with surgery, (73.7% vs. 92.4%, respectively, p<0.001). 3-year DSS for patients with high grade tumors was worse when compared to patients with low grade tumors (65.1% vs. 82.9%, respectively, p<0.0001). The 3-year cumulative CSM was 26.3%. On multivariable analysis, older age (Hazard ratio (HR): 1.05, p<0.001) and high tumor grade (HR: 1.88, p<0.001) were predictors of worse outcome.

In this population based cohort, 7.6% of UTUC patients were managed with a non-definitive approach. Median OS for the untreated cohort was significantly shorter compared to the surgical cohort (1.9 vs. 7.8 years, respectively). These data may be helpful in counseling patients who are poor surgical candidates, as non-definitive therapy may provide reasonable oncologic outcomes. This article is protected by copyright. All rights reserved.

BJU international. 2017 Oct 03 [Epub ahead of print]

Jamil S Syed, Kevin A Nguyen, Alfredo Suarez-Sarmiento, Katelyn Johnson, Michael S Leapman, Jay D Raman, Brian Shuch

Department of Urology, Yale School of Medicine, New Haven, CT., Division of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA.