Survival outcomes for patients with localised upper tract urothelial carcinoma managed with non‐definitive treatment

• Published in: BJU international Vol. 121; no. 1; pp. 124 - 129
• Main Authors: Syed, Jamil S., Nguyen, Kevin A., Suarez‐Sarmiento, Alfredo, Johnson, Katelyn, Leapman, Michael S., Raman, Jay D., Shuch, Brian
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.01.2018
• Subjects: Age Factors; Aged; Aged, 80 and over; Bladder cancer; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - therapy; Cohort Studies; Conservative Treatment - methods; Disease-Free Survival; disease‐specific survival; Epidemiology; Female; Geriatric Assessment - methods; Humans; Kaplan-Meier Estimate; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Kidney Neoplasms - therapy; Kidneys; Male; Neoplasm Invasiveness - pathology; Neoplasm Staging; overall survival; Patient Selection; Patients; Pelvis; Prognosis; Proportional Hazards Models; Risk Assessment; SEER Program; Surgery; Survival; Survival Analysis; Treatment Outcome; Tumors; United States; Ureter; Ureteral Neoplasms - mortality; Ureteral Neoplasms - pathology; Ureteral Neoplasms - therapy; Urothelial carcinoma; utuc; watchful waiting; overall survival; disease-specific survival; urothelial carcinoma; utuc; watchful waiting; surgery
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.14042

Objective To investigate the outcomes of patients with upper tract urothelial carcinoma (UTUC) with non‐definitive therapy, which currently remains unknown. Patients and Methods We used the Surveillance, Epidemiology, and End Results (SEER) database to identify individuals with a localised, histologically confirmed kidney/renal pelvis and ureteric UC. Survival analysis using the Kaplan–Meier method was performed. A competing risk model evaluated the cumulative incidence and predictors of cancer‐specific mortality (CSM). Results We identified 633 (7.6%) individuals who did not receive surgery. These individuals were significantly older (median age 81 vs 71 years, P < 0.001) than surgically managed patients. The median overall survival (OS) was significantly shorter compared to the surgical cohort (1.9 vs 7.8 years, P < 0.001). The 3‐year disease‐specific survival (DSS) for patients without surgery was significantly lower compared to those with surgery, at 73.7% vs 92.4%, respectively (P < 0.001). The 3‐year DSS for patients with high‐grade tumours was worse when compared to patients with low‐grade tumours, at 65.1% vs 82.9%, respectively (P < 0.001). The 3‐year cumulative CSM was 26.3%. On multivariable analysis, older age (hazard ratio [HR] 1.05, P < 0.001) and high tumour grade (HR 1.88, P < 0.001) were predictors of worse outcomes. Conclusions In this population‐based cohort, 7.6% of patients with UTUC were managed with a non‐definitive approach. The median OS for the untreated cohort was significantly shorter compared to the surgical cohort (1.9 vs 7.8 years, respectively). These data may be helpful in counselling patients who are poor surgical candidates, as non‐definitive therapy may provide reasonable oncological outcomes.