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

Asian J Surg. 2023 Aug;46(8):3058-3065. doi: 10.1016/j.asjsur.2022.10.046. Epub 2022 Oct 29.

Authors

Affiliations

¹ Department of Urology, Postal Hospital, Taipei, Taiwan; Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan.
² Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
³ Department of Urology, China Medical University Hospital, Taichung, 40447, Taiwan; School of Medicine, China Medical University, Taichung, 40402, Taiwan; Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, 40402, Taiwan.
⁴ Division of Urology, Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan. Electronic address: tsai1970523@yahoo.com.tw.
⁵ Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁶ Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁷ Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
⁸ Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252, Taiwan; Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan No.155, Sec.2, Linong Street, Taipei, 112, Taiwan.
⁹ Division of Urology, Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
¹⁰ College of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan; Department of Urology, Cardinal Tien Hospital, New Taipei City, 23148, Taiwan; Department of Life Science, College of Science, National Taiwan Normal University, Taipei, 11677, Taiwan.
¹¹ Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taiwan; Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹² Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹³ Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Taiwan; Department of Healthcare Information＆Management, Ming Chuan University, Taiwan.

PMID: 37525448
DOI: 10.1016/j.asjsur.2022.10.046

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.

MeSH terms

Carcinoma, Transitional Cell* / pathology
Carcinoma, Transitional Cell* / surgery
Humans
Hydronephrosis*
Retrospective Studies
Taiwan / epidemiology
Ureteral Neoplasms* / pathology
Ureteral Neoplasms* / surgery
Ureteroscopy
Urinary Bladder Neoplasms*