MP69-07 ONCOLOGICAL OUTCOMES OF SECOND-LOOK URETEROSCOPY FOR UPPER TRACT UROTHELIAL CARCINOMA: A SINGLE CENTER EXPERIENCE

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You have accessJournal of UrologyCME1 Apr 2023MP69-07 ONCOLOGICAL OUTCOMES OF SECOND-LOOK URETEROSCOPY FOR UPPER TRACT UROTHELIAL CARCINOMA: A SINGLE CENTER EXPERIENCE Andrea Gallioli, Giuseppe Basile, Paolo Verri, Angelo Territo, Paula Izquierdo, Jose Maria Gaya, Francesco Sanguedolce, Alessandro Uleri, Julia Aumatell, Jorge Huguet, Joan Palou, and Alberto Breda Andrea GallioliAndrea Gallioli More articles by this author , Giuseppe BasileGiuseppe Basile More articles by this author , Paolo VerriPaolo Verri More articles by this author , Angelo TerritoAngelo Territo More articles by this author , Paula IzquierdoPaula Izquierdo More articles by this author , Jose Maria GayaJose Maria Gaya More articles by this author , Francesco SanguedolceFrancesco Sanguedolce More articles by this author , Alessandro UleriAlessandro Uleri More articles by this author , Julia AumatellJulia Aumatell More articles by this author , Jorge HuguetJorge Huguet More articles by this author , Joan PalouJoan Palou More articles by this author , and Alberto BredaAlberto Breda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: According to EAU guidelines, second-look ureteroscopy (SU) could be performed 6-8 weeks after primary endoscopic treatment. We aimed at assessing the impact of positive SU on radical nephroureterectomy-free survival (RNU-FS) and cancer specific survival (CSS) in patients endoscopically treated (URS) for a suspicion of upper tract urothelial carcinoma (UTUC). METHODS: We relied on a prospectively maintained single-institution database (2015-2021) of patients with a suspicion of UTUC. Kaplan-Meyer method estimated the 2-year RNU-FS and CSS according to SU results. Multivariable Cox regression (MCR) analyses were implemented to investigate the relationship between SU outcome and the probability of RNU-FS and CSS after adjusting for age, previous radical cystectomy, tumor grade, focality and dimension. Finally, multivariable logistic regression (MLR) analysis investigated predictors of negative SU after adjusting for tumor and patients’ characteristics. RESULTS: Overall, among 360 patients undergone URS, 85 (23.6%) patients underwent SU. No difference emerged between the two cohorts (positive vs negative SU) in terms of previous history of urothelial cancer, tumor focality and histology grading of the primary lesion. In positive SU group, tumors were larger (>20mm, p=0.03) and classified as high-risk (p<0.001). SU detected tumors in 38 (44.7%) cases. After a median follow-up of 35 (IQR: 15-56) months, 2 (5.2%) and 11 (28.9%) underwent upfront and subsequent RNU in the positive SU cohort, respectively. When comparing the two cohorts, the 2-yr RNU-FS rates were 96.7% (95% CI 90.7-100) and 64.7% (95% CI 50.9-82.2) (p=0.001), while the 2-yr CSS rates were 97.8% (95% CI 93.6-100) and 90.3% (95% CI 80.4-100) (p=0.32), respectively. At MCR analyses, positive SU (HR: 4.56, 95%CI 0.91-22.81, p=0.04) and tumor grade (HR: 3.87, 95%CI 1.08-13.77, p=0.03) were predictors of radical treatment. At MLR, patients with unifocal, low grade tumor with a dimension <10mm had higher probability to have a negative SU (OR: 3.68, 95%CI 1.50-9.44, p=0.005) compared to patients with large, high grade and multifocal tumor. CONCLUSIONS: Almost 45% of candidates to SU are diagnosed with UTUC, especially when harboring high-risk features at first URS. Positive SU is associated with higher rates of subsequent radical treatment, which reflects in a similar CSS when compared to patients with negative SU. In patients with unifocal, low grade and small UTUC, the replacement of SU with CT scan could be considered. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e966 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrea Gallioli More articles by this author Giuseppe Basile More articles by this author Paolo Verri More articles by this author Angelo Territo More articles by this author Paula Izquierdo More articles by this author Jose Maria Gaya More articles by this author Francesco Sanguedolce More articles by this author Alessandro Uleri More articles by this author Julia Aumatell More articles by this author Jorge Huguet More articles by this author Joan Palou More articles by this author Alberto Breda More articles by this author Expand All Advertisement PDF downloadLoading ...