NEW YORK (Reuters Health) – In selected patients with upper tract urothelial carcinoma, endoscopic management offers a nephron-sparing alternative to nephroureterectomy, researchers report in the June issue of the Journal of Urology.

“Endoscopic treatment of upper tract urothelial cancer is a great alternative to complete removal of the kidney in cases of low grade cancer,” senior author Dr. J. Stuart Wolf Jr. told Reuters Health by e-mail. The endoscopic approach offers “a lower risk of complications, and major surgery with loss of kidney function can be avoided, but both the patient and the urologist must accept the high burden of repeated treatments,” he said.

Dr. Wolf and colleagues at the University of Michigan Health System, Ann Arbor, reviewed data on 96 kidneys (from 93 patients), including 62 resected via nephroureterectomy and 34 managed endoscopically. (The 34 kidneys managed endoscopically required 46 procedures for complete initial resection, their report notes.)

Almost half of the patients treated endoscopically had imperative indications for nephron sparing, including bilateral disease, solitary kidney and chronic renal insufficiency.

After a median follow-up of about 6.5 years, complication rates were significantly lower after endoscopic management than after nephroureterectomy (9.3% vs. 29%).

Five-year metastasis-free survival with endoscopy vs nephroureterectomy was 94.4% vs 87.8%, respectively, in patients with low-grade tumors and 85.7% vs 63.5%, respectively, with high-grade tumors.

The 5-year cancer-specific survival rates with endoscopy vs nephroureterectomy were 89% and 72%, respectively. For overall survival, the rates were 100% and 75%, respectively.

Eleven kidneys (32.4%) that were initially managed endoscopically eventually required nephroureterectomy or partial nephrectomy, after a mean interval of 21.4 months (median, 10.3 months).

Tumor grade alone was significantly associated with metastasis-free survival. Grade and body mass index correlated with cancer-specific survival, and Charlson Comorbidity index and grade influenced overall survival.

“The corollary of this,” Dr. Wolf concluded, “is that for high grade cancer, endoscopic treatment is not recommended in most circumstances.”

Reference:
J Urol 2010;183:2148-2153.