期刊
INTERNATIONAL UROLOGY AND NEPHROLOGY
卷 52, 期 8, 页码 1465-1469出版社
SPRINGER
DOI: 10.1007/s11255-020-02439-5
关键词
Disease progression; Endoscopy; Ureteral neoplasms; Urothelial carcinoma
资金
- Agency for Healthcare Research and Quality [R24 HS19455] Funding Source: Medline
- AHRQ HHS [R24 HS019455] Funding Source: Medline
- National Institute of Diabetes and Digestive and Kidney [K08DK097302-01A1] Funding Source: Medline
- NCATS NIH HHS [UL1 TR002345, UL1 TR000448] Funding Source: Medline
- NCI NIH HHS [KM1CA156708, KM1 CA156708, P30 CA008748] Funding Source: Medline
- NIDDK NIH HHS [K08 DK097302] Funding Source: Medline
- NIH HHS [UL1 TR000448, P30 CA008748] Funding Source: Medline
Purpose Patients undergoing endoscopic management for upper tract urothelial carcinoma often progress to definitive therapy with radical nephroureterectomy. This study examined the rate of progression as well as risk factors for transitions in treatment over time. Methods Retrospective review at two institutions identified patients undergoing endoscopic management for upper tract urothelial carcinoma. Patients were assessed for progression to radical nephroureterectomy. Baseline characteristics were compared using Chi square analysis. Kaplan-Meier method analyzed the probability of patients not progressing to radical nephroureterectomy. Cox proportional hazards identified factors associated with progression to radical nephroureterectomy. Results Eighty-one patients had endoscopic management alone and 89 progressed to radical nephroureterectomy. The two groups had similar age, histories of bladder cancer, and Charlson comorbidity index. Positive urinary cytology, ureteroscopic visualization, and biopsy grade were higher in those progressing to RNU (p < 0.001). Hazard modeling demonstrated higher rates of progression to radical nephroureterectomy with positive biopsy (HR 11.8, 95% CI 2.4-59.5,p = 0.003) or visible lesion on ureteroscopy (HR 8.4, 95% CI 3.0-23.9,p < 0.001). Patients with a higher Charlson comorbidity index were less likely to have radical nephroureterectomy. On Kaplan-Meier modeling, the probability of not undergoing radical nephroureterectomy at 2 years and 5 years was 50% and 20%, respectively. Conclusions Patients who progress to radical nephroureterectomy after endoscopic management have fewer comorbid conditions and changes in disease status including visible lesions on ureteroscopy and positive biopsies. The high rate of progression to radical nephroureterectomy reinforces the need for long-term follow-up of these patients.
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