630 NEPHRON SPARING MANAGEMENT VERSUS NEPHROURETERECTOMY FOR LOW GRADE LOW STAGE UPPER TRACT UROTHELIAL CANCERS (UTUC): A SEER ANALYSIS

Abstract

You have accessJournal of UrologyUrothelial Cancer: Upper Tract Tumors1 Apr 2012630 NEPHRON SPARING MANAGEMENT VERSUS NEPHROURETERECTOMY FOR LOW GRADE LOW STAGE UPPER TRACT UROTHELIAL CANCERS (UTUC): A SEER ANALYSIS Jay Simhan, Marc Smaldone, Brian Egleston, Daniel Canter, Anthony Corcoran, Serge Ginzburg, Steven Sterious, Jose Reyes, Robert Uzzo, and Alexander Kutikov Jay SimhanJay Simhan Philadelphia, PA More articles by this author , Marc SmaldoneMarc Smaldone Philadelphia, PA More articles by this author , Brian EglestonBrian Egleston Philadelphia, PA More articles by this author , Daniel CanterDaniel Canter Atlanta, GA More articles by this author , Anthony CorcoranAnthony Corcoran Philadelphia, PA More articles by this author , Serge GinzburgSerge Ginzburg Philadelphia, PA More articles by this author , Steven SteriousSteven Sterious Philadelphia, PA More articles by this author , Jose ReyesJose Reyes Philadelphia, PA More articles by this author , Robert UzzoRobert Uzzo Philadelphia, PA More articles by this author , and Alexander KutikovAlexander Kutikov Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.709AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent reports suggest equivalent oncologic efficacy for low grade low stage upper tract urothelial cancers (UTUC) managed with more conservative nephron-sparing measures (endoscopic ablation, segmental ureterectomy) compared to traditional nephroureterectomy (NTxU). Using Surveillance, Epidemiology, and End Results (SEER) data, we compared overall and cancer specific outcomes for UTUC between patients managed with NTxU and those managed with nephron preservation. METHODS Using the SEER registries from 1992-2008, patients with a diagnosis of low grade Ta or T1 N0M0 UTUC of the renal pelvis and/or ureter were identified and stratified into two groups: those treated with NTxU or by NSS (observation, endoscopic ablation, or segmental ureterectomy). Cancer specific mortality and non-cancer specific mortality rates were determined at different time points using cumulative incidence estimators. We used Cox regressions for overall survival and Fine and Gray regressions for cause specific mortality analyses. RESULTS Of the 1,227 patients (mean age 70.2±11.0 yrs, 63.2% male) meeting study inclusion criteria, 907 (73.9%, 62.3% male) and 320 (26.1%, 65.6% male) patients underwent NTxU and non-extirpative NSS for the management of low grade, low stage UTUC from 1992-2008 respectively. Conservatively managed patients were older (mean age 71.6 vs. 69.7 yrs, p<0.01) with a greater proportion of well differentiated (G1) tumors (26.3% vs. 18.0%, p=0.001). There were no differences between groups with regard to gender, marriage status, nor race. While there were differences in other cause mortality observed between the two groups (p<0.01), cancer-specific mortality trends were similar (Figure 1). Controlling for grade, demographics, and year of diagnosis, patients treated with NTxU had longer non-cancer cause survival (HR=0.78, p=0.009), without a cancer-specific mortality benefit. CONCLUSIONS Patients with low grade low stage UTUC managed conservatively appear to have similar cancer-specific survival rates to those managed with NTxU. These data may be useful when counseling UTUC patients with baseline chronic kidney disease or other significant competing comorbidities. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e256-e257 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jay Simhan Philadelphia, PA More articles by this author Marc Smaldone Philadelphia, PA More articles by this author Brian Egleston Philadelphia, PA More articles by this author Daniel Canter Atlanta, GA More articles by this author Anthony Corcoran Philadelphia, PA More articles by this author Serge Ginzburg Philadelphia, PA More articles by this author Steven Sterious Philadelphia, PA More articles by this author Jose Reyes Philadelphia, PA More articles by this author Robert Uzzo Philadelphia, PA More articles by this author Alexander Kutikov Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...