Endoscopic management of upper tract urothelial cancer in a highly endemic area: A Taiwan nationwide collaborative study

Yung Tai Chen; Hsin Chih Yeh; Hsiang Ying Lee; Po Fan Hsieh; Eric Chieh lung Chou; Yao Chou Tsai; Jian Hua Hong; Chao Yuan Huang; Yuan Hong Jiang; Yu Khun Lee; Jen Shu Tseng; Chih Chin Yu; Bing Juin Chiang; Thomas Y. Hsueh; Chia Chang Wu; Chung You Tsai

doi:10.1016/j.asjsur.2022.10.046

Endoscopic management of upper tract urothelial cancer in a highly endemic area: A Taiwan nationwide collaborative study

Yung Tai Chen, Hsin Chih Yeh, Hsiang Ying Lee, Po Fan Hsieh, Eric Chieh lung Chou, Yao Chou Tsai, Jian Hua Hong, Chao Yuan Huang, Yuan Hong Jiang, Yu Khun Lee, Jen Shu Tseng, Chih Chin Yu, Bing Juin Chiang, Thomas Y. Hsueh, Chia Chang Wu, Chung You Tsai

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2 Scopus citations

Abstract

Background: Endoscopic management of upper tract urothelial cancer (UTUC) is an important treatment option for low risk UTUC. Although Taiwan is an endemic area for UTUC, endoscopic treatment outcomes in Taiwan are frequently under- reported. Methods: This study retrospectively reviewed the treatment outcomes of endoscopic management for clinically localized UTUC. Patients with biopsy or washing cytology confirmed UTUC who underwent endoscopic or percutaneous management with a curative intent were retrospectively reviewed for eligibility of analysis. Those cases without pre-intervention confirmed UTUC, and metastatic or nodal disease at diagnosis were excluded. Results: In total, 307 patients who underwent endoscopic management were reviewed and 279 cases were eligible for final analysis. With a median follow-up of 44.3 months (inter-quartile range (IQR): 23.4–76.4 months), 117 cases (46.4%) were endoscopic cured after median one session (range:1–8; IQR:1–2) of endoscopic treatment. Those endoscopic cured UTUC was associated with more small-sized tumor, more low-grade biopsied-histology, less concomitant bladder UC and less pre-operative hydronephrosis. In addition, 201(79.7%) cases among 252 cases with confirmed oncological outcome were free of UTUC at the end of follow-up and only 43 (17%) patients had a UTUC related mortality. Salvage RNU offered a better tumor free survival rate (92% vs. 77.5%) than those without salvage RNU in those UTUC refractory to endoscopic management. In multivariable analyses, pre-operative hydronephrosis was the independent risk factor for OS. Multiplicity and concomitant bladder UC were independent risk factors for DFS. Conclusions: We confirmed the consistent safety and efficacy of endoscopic management of clinical localized UTUC in a highly UTUC endemic area like Taiwan. Early salvage RNU is mandatory in those UTUC refractory to endoscopic management in prevention of UTUC related death.

Original language	English (US)
Pages (from-to)	3058-3065
Number of pages	8
Journal	Asian Journal of Surgery
Volume	46
Issue number	8
DOIs	https://doi.org/10.1016/j.asjsur.2022.10.046
State	Published - Aug 2023
Externally published	Yes

Keywords

Endoscopic management
Nephroureterectomy
Upper urinary tract urothelial cancer
Ureteroscopy

ASJC Scopus subject areas

Surgery

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10.1016/j.asjsur.2022.10.046

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Chen, Y. T., Yeh, H. C., Lee, H. Y., Hsieh, P. F., Chou, E. C. L., Tsai, Y. C., Hong, J. H., Huang, C. Y., Jiang, Y. H., Lee, Y. K., Tseng, J. S., Yu, C. C., Chiang, B. J., Hsueh, T. Y., Wu, C. C., & Tsai, C. Y. (2023). Endoscopic management of upper tract urothelial cancer in a highly endemic area: A Taiwan nationwide collaborative study. Asian Journal of Surgery, 46(8), 3058-3065. https://doi.org/10.1016/j.asjsur.2022.10.046

Chen, YT, Yeh, HC, Lee, HY, Hsieh, PF, Chou, ECL, Tsai, YC, Hong, JH, Huang, CY, Jiang, YH, Lee, YK, Tseng, JS, Yu, CC, Chiang, BJ, Hsueh, TY, Wu, CC & Tsai, CY 2023, 'Endoscopic management of upper tract urothelial cancer in a highly endemic area: A Taiwan nationwide collaborative study', Asian Journal of Surgery, vol. 46, no. 8, pp. 3058-3065. https://doi.org/10.1016/j.asjsur.2022.10.046

@article{38b3b7f866bb4058b4319259431b04ce,

title = "Endoscopic management of upper tract urothelial cancer in a highly endemic area: A Taiwan nationwide collaborative study",

abstract = "Background: Endoscopic management of upper tract urothelial cancer (UTUC) is an important treatment option for low risk UTUC. Although Taiwan is an endemic area for UTUC, endoscopic treatment outcomes in Taiwan are frequently under- reported. Methods: This study retrospectively reviewed the treatment outcomes of endoscopic management for clinically localized UTUC. Patients with biopsy or washing cytology confirmed UTUC who underwent endoscopic or percutaneous management with a curative intent were retrospectively reviewed for eligibility of analysis. Those cases without pre-intervention confirmed UTUC, and metastatic or nodal disease at diagnosis were excluded. Results: In total, 307 patients who underwent endoscopic management were reviewed and 279 cases were eligible for final analysis. With a median follow-up of 44.3 months (inter-quartile range (IQR): 23.4–76.4 months), 117 cases (46.4%) were endoscopic cured after median one session (range:1–8; IQR:1–2) of endoscopic treatment. Those endoscopic cured UTUC was associated with more small-sized tumor, more low-grade biopsied-histology, less concomitant bladder UC and less pre-operative hydronephrosis. In addition, 201(79.7%) cases among 252 cases with confirmed oncological outcome were free of UTUC at the end of follow-up and only 43 (17%) patients had a UTUC related mortality. Salvage RNU offered a better tumor free survival rate (92% vs. 77.5%) than those without salvage RNU in those UTUC refractory to endoscopic management. In multivariable analyses, pre-operative hydronephrosis was the independent risk factor for OS. Multiplicity and concomitant bladder UC were independent risk factors for DFS. Conclusions: We confirmed the consistent safety and efficacy of endoscopic management of clinical localized UTUC in a highly UTUC endemic area like Taiwan. Early salvage RNU is mandatory in those UTUC refractory to endoscopic management in prevention of UTUC related death.",

keywords = "Endoscopic management, Nephroureterectomy, Upper urinary tract urothelial cancer, Ureteroscopy",

author = "Chen, {Yung Tai} and Yeh, {Hsin Chih} and Lee, {Hsiang Ying} and Hsieh, {Po Fan} and Chou, {Eric Chieh lung} and Tsai, {Yao Chou} and Hong, {Jian Hua} and Huang, {Chao Yuan} and Jiang, {Yuan Hong} and Lee, {Yu Khun} and Tseng, {Jen Shu} and Yu, {Chih Chin} and Chiang, {Bing Juin} and Hsueh, {Thomas Y.} and Wu, {Chia Chang} and Tsai, {Chung You}",

note = "Publisher Copyright: {\textcopyright} 2023 Asian Surgical Association and Taiwan Robotic Surgery Association",

year = "2023",

month = aug,

doi = "10.1016/j.asjsur.2022.10.046",

language = "English (US)",

volume = "46",

pages = "3058--3065",

journal = "Asian Journal of Surgery",

issn = "1015-9584",

publisher = "Elsevier Taiwan LLC",

number = "8",

}

TY - JOUR

T1 - Endoscopic management of upper tract urothelial cancer in a highly endemic area

T2 - A Taiwan nationwide collaborative study

AU - Chen, Yung Tai

AU - Yeh, Hsin Chih

AU - Lee, Hsiang Ying

AU - Hsieh, Po Fan

AU - Chou, Eric Chieh lung

AU - Tsai, Yao Chou

AU - Hong, Jian Hua

AU - Huang, Chao Yuan

AU - Jiang, Yuan Hong

AU - Lee, Yu Khun

AU - Tseng, Jen Shu

AU - Yu, Chih Chin

AU - Chiang, Bing Juin

AU - Hsueh, Thomas Y.

AU - Wu, Chia Chang

AU - Tsai, Chung You

PY - 2023/8

Y1 - 2023/8

N2 - Background: Endoscopic management of upper tract urothelial cancer (UTUC) is an important treatment option for low risk UTUC. Although Taiwan is an endemic area for UTUC, endoscopic treatment outcomes in Taiwan are frequently under- reported. Methods: This study retrospectively reviewed the treatment outcomes of endoscopic management for clinically localized UTUC. Patients with biopsy or washing cytology confirmed UTUC who underwent endoscopic or percutaneous management with a curative intent were retrospectively reviewed for eligibility of analysis. Those cases without pre-intervention confirmed UTUC, and metastatic or nodal disease at diagnosis were excluded. Results: In total, 307 patients who underwent endoscopic management were reviewed and 279 cases were eligible for final analysis. With a median follow-up of 44.3 months (inter-quartile range (IQR): 23.4–76.4 months), 117 cases (46.4%) were endoscopic cured after median one session (range:1–8; IQR:1–2) of endoscopic treatment. Those endoscopic cured UTUC was associated with more small-sized tumor, more low-grade biopsied-histology, less concomitant bladder UC and less pre-operative hydronephrosis. In addition, 201(79.7%) cases among 252 cases with confirmed oncological outcome were free of UTUC at the end of follow-up and only 43 (17%) patients had a UTUC related mortality. Salvage RNU offered a better tumor free survival rate (92% vs. 77.5%) than those without salvage RNU in those UTUC refractory to endoscopic management. In multivariable analyses, pre-operative hydronephrosis was the independent risk factor for OS. Multiplicity and concomitant bladder UC were independent risk factors for DFS. Conclusions: We confirmed the consistent safety and efficacy of endoscopic management of clinical localized UTUC in a highly UTUC endemic area like Taiwan. Early salvage RNU is mandatory in those UTUC refractory to endoscopic management in prevention of UTUC related death.

AB - Background: Endoscopic management of upper tract urothelial cancer (UTUC) is an important treatment option for low risk UTUC. Although Taiwan is an endemic area for UTUC, endoscopic treatment outcomes in Taiwan are frequently under- reported. Methods: This study retrospectively reviewed the treatment outcomes of endoscopic management for clinically localized UTUC. Patients with biopsy or washing cytology confirmed UTUC who underwent endoscopic or percutaneous management with a curative intent were retrospectively reviewed for eligibility of analysis. Those cases without pre-intervention confirmed UTUC, and metastatic or nodal disease at diagnosis were excluded. Results: In total, 307 patients who underwent endoscopic management were reviewed and 279 cases were eligible for final analysis. With a median follow-up of 44.3 months (inter-quartile range (IQR): 23.4–76.4 months), 117 cases (46.4%) were endoscopic cured after median one session (range:1–8; IQR:1–2) of endoscopic treatment. Those endoscopic cured UTUC was associated with more small-sized tumor, more low-grade biopsied-histology, less concomitant bladder UC and less pre-operative hydronephrosis. In addition, 201(79.7%) cases among 252 cases with confirmed oncological outcome were free of UTUC at the end of follow-up and only 43 (17%) patients had a UTUC related mortality. Salvage RNU offered a better tumor free survival rate (92% vs. 77.5%) than those without salvage RNU in those UTUC refractory to endoscopic management. In multivariable analyses, pre-operative hydronephrosis was the independent risk factor for OS. Multiplicity and concomitant bladder UC were independent risk factors for DFS. Conclusions: We confirmed the consistent safety and efficacy of endoscopic management of clinical localized UTUC in a highly UTUC endemic area like Taiwan. Early salvage RNU is mandatory in those UTUC refractory to endoscopic management in prevention of UTUC related death.

KW - Endoscopic management

KW - Nephroureterectomy

KW - Upper urinary tract urothelial cancer

KW - Ureteroscopy

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Endoscopic management of upper tract urothelial cancer in a highly endemic area: A Taiwan nationwide collaborative study

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Keywords

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