Endoscopic kidney-sparing surgery (eKSS) for high-grade (HG) upper tract urothelial carcinoma (UTUC) is still matter of debate. We quantified the oncological outcomes, namely UTUC recurrence-free survival (RFS), UTUC progression-free survival (PFS), radical nephroureterectomy (RNU)-free survival, bladder recurrence-free survival (BCAR), cancer-specific mortality (CSM) and other-cause mortality (OCM), of these patients.
We relied on a multicentre retrospective database (UTUC registry) including 358 UTUC patients who underwent eKSS with curative intent between 2010 and 2021. Kaplan-Meyer plots depicted the following oncological outcomes: UTUC RFS, UTUC-PFS, RNU-free survival, BCAR, CSM and OCM.
Based on a median follow-up of 27 months, 72 HG UTUC patients were identified. Of those, 50 (69%) harbored an elective indication for conservative management. According to tumor characteristics, 43 (60%) harbored a tumor size ≥2 cm, 30 (42%) UTUC patients exhibited positive cytology, and 25 (35%) were multifocal. According to their urothelial tumor history, 25 (35%) presented previous BCA, 22 (31%) synchronous BCA, 15 (21%) previous UTUC, and 4 (5.6%) previous RC. The 2-years RNU-free survival, UTUC PFS, and BCAR-free survival rates were 64%, 79%, and 84%, respectively. The 2-year CSM rate was 9% and 2-year OCM rate was 20%.
Within the current study, eKSS might be an option to delay radical surgery in patients with high grade apparently noninvasive disease with increased comorbidities and decreased life expectancy. Specifically, this approach may represent an option in selected patients with HG UTUC, where OCM almost doubled CSM.
Urologic oncology. 2026 Mar 23 [Epub ahead of print]
Francesco Di Bello, Benjamin Pradere, Ekaterina Laukhtina, David D'Andrea, Francesco Del Giudice, Benjamin I Chung, Wojciech Krajewski, Fabio Zattoni, Francesco Soria, Luca Afferi, Gautier Marcq, Elisa De Lorenzis, Marco Moschini, Andrea Mari, José Daniel Subiela, Simone Albisinni, Paula Izquierdo, Lucía Diéguez, Giulio Avesani, Angelo Territo, Giuseppe Basile, Joan Palou, Alberto Breda, Andrea Gallioli, EAU-YAU Urothelial Working Group and Ureteroscopic Treatment of upper tract Urothelial Carcinoma (UTUC) registry
Urology, Fundació Puigvert, Barcelona, Spain; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy. Electronic address: ., Urology, Urosud La Croix du Sud Hospital, Quint Fonsegrives, France., Department of Urology, Comprehensive Cancer Center and Medical University of Vienna, Vienna, Austria., Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy., Department of Urology, Stanford University School of Medicine, Stanford, CA., Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland., Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy., Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy., Urology, Luzerner Kantonsspital, Luzern, Switzerland; Department of Urology, Kantoonsspital Aarau, Aarau, Switzerland., Urology, Claude Huriez Hospital, Lille, France., Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy., Urology, IRCCS San Raffaele Hospital, Milan, Italy., Urological Robotic Surgery and Renal Transplantation Florence, University of Florence and Careggi Hospital, Florence, Italy., Urology, Hospital Universitario Ramón y Cajal IRYCIS Universidad de Alcalá, Madrid, Spain., Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy., Urology, Fundació Puigvert, Barcelona, Spain., Urology, Fundació Puigvert, Barcelona, Spain; Urology, IRCCS San Raffaele Hospital, Milan, Italy., Urology, Fundació Puigvert, Barcelona, Spain; Institut de Recerca de Sant Pau, Hospital de la Santa Crux de Sant Pau, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41876328