MP48-07 EFFECT OF DELAY TO NEPHROURETERECTOMY AFTER KIDNEY-SPARING TREATMENTS ON PATHOLOGIC AND SURVIVAL OUTCOMES FOR UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP48)1 Sep 2021MP48-07 EFFECT OF DELAY TO NEPHROURETERECTOMY AFTER KIDNEY-SPARING TREATMENTS ON PATHOLOGIC AND SURVIVAL OUTCOMES FOR UPPER TRACT UROTHELIAL CARCINOMA Jamie S. Pak, Ezra J. Margolin, Kevin Lee, and Christopher B. Anderson Jamie S. PakJamie S. Pak More articles by this author , Ezra J. MargolinEzra J. Margolin More articles by this author , Kevin LeeKevin Lee More articles by this author , and Christopher B. AndersonChristopher B. Anderson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002074.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Though radical nephroureterectomy (RNU) is the standard of care for upper tract urothelial carcinoma (UTUC), many patients desire kidney-sparing treatments, including endoscopic resection, upper tract topical therapies, and segmental ureterectomy. There are risks of both recurrence and progression with kidney-sparing treatments for UTUC. We compared pathologic and survival outcomes of immediate versus delayed RNU after a trial of kidney-sparing treatments. Our hypothesis was that patients who required delayed RNU after kidney-sparing treatments did not have more advanced cancers or worsened survival than those undergoing immediate RNU. METHODS: We retrospectively reviewed all patients with UTUC who underwent RNU at our institution from 2011-2018. The delayed RNU cohort included patients who were selected for radical surgery after initially pursuing kidney-sparing treatments. Pathologic outcomes were tumor grade, stage, margin status, and lymph node involvement at RNU. Survival outcomes included recurrence-free, progression-free, and overall survival. RESULTS: Of 100 patients, 77 and 23 patients underwent immediate and delayed RNU, respectively. At pre-treatment biopsy, the rates of high grade (HG) disease, lamina propria invasion, and positive cytology were not significantly different between cohorts, though CIS was more common in the delayed RNU cohort (35% vs. 10%). Treatments before delayed RNU were endoscopic resection (n=5), topical therapy (n=8), and segmental ureterectomy (n=10). Median times from diagnosis to RNU were 46 vs. 427 days for the immediate and delayed RNU cohorts, respectively. At RNU, rates of HG disease, stage ≥pT2, positive margins, and lymph node positivity were not significantly different between the two groups. On multivariate analysis, delayed RNU was not associated with stage ≥pT2 or HG disease at RNU. With median follow-up of 21 and 25 months in the immediate and delayed RNU cohorts, respectively, median recurrence-free (14 vs. 7 months), progression-free (60 months vs. not reached [NR]), and overall survival (81 months vs. NR) from RNU were not significantly different between cohorts. CONCLUSIONS: We did not observe any statistically significant difference in pathologic and survival outcomes in patients undergoing immediate and delayed RNU. Further research is needed to determine if patients eligible for kidney-sparing who undergo immediate RNU have similar outcomes as those who undergo delayed RNU after conservative management. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e866-e866 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jamie S. Pak More articles by this author Ezra J. Margolin More articles by this author Kevin Lee More articles by this author Christopher B. Anderson More articles by this author Expand All Advertisement PDF downloadLoading ...