Endoscopic Treatment for Large Multifocal Upper Tract Urothelial Carcinoma.

We reviewed the oncologic and surgical outcomes of endoscopic treatments for low-grade upper tract urothelial carcinoma (UTUC), and assessed the prognostic significance of tumor size, location, and multifocality.

A retrospective review of all patients who underwent endoscopic treatment for low-grade UTUC at our institution between 2014-2019. Tumors were treated with a dual-laser generator which alternatively produces holmium and neodymium lasers. A stringent ureteroscopic follow-up 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.

The cohort included 59 patients (62 renal units), 27% of tumors were multifocal and 40% were >2 cm. The median follow-up time was 22 months (IQR 11-41), and the median number of ureteroscopies was 5.5 (4-9). Local recurrence occurred 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 to radical surgery: two had pathological progression and two had a rapid and high-volume local recurrence, one 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.

Ureteroscopic treatment of large, multifocal low-grade UTUC is feasible, does not involve significant complications, and has good short-term oncologic outcome, with a 93.2% progression-free survival rate. Tumors located in the kidney and multifocality yielded shorter time to local recurrence but not progression.

The Journal of urology. 2020 Nov 20 [Epub ahead of print]

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

The Department of Urology, Sheba Medical Center, Tel Hashomer, Israel., The Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel., The Department of Pathology, Sheba Medical Center, Tel Hashomer, Israel.

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