MP70-01 EXTIRPATIVE TREATMENT OF UPPER URINARY TRACT UROTHELIAL CARCINOMA: A 15-YEAR COMPREHENSIVE REVIEW

Abstract

INTRODUCTION AND OBJECTIVES: Extirpative treatment of Upper Urinary Tract Urothelial Carcinoma (UTUC) has long been the standard of care regardless of tumor grade. We herein stratify oncologic outcomes based on tumor grade with implications for the role of systemic chemotherapy. We present long-term oncologic outcomes of all patients treated with nephroureterectomy (NU) for UTUC over a 15 year time period. METHODS: All patients (N1⁄480) were treated by a single surgeon with extirpative surgery for UTUC as a primary treatment. The majority (90%) underwent laparoscopic NU via a retroperitoneal approach, with transurethral incision of the ureteric orifice and then open bladder-cuff excision through a Gibson incision. The open surgical approach was used in 6 (7.5%) cases and distal/ segmental ureterectomy only was used sparingly (2.5%). Data was prospectively collected and concurrent outpatient follow up data were retrospectively reviewed. Statistical analysis was performed using Kaplan Meier methodology to calculate overall survival (OS), cancer specific survival (CSS), and metastasis-free survival (MFS). RESULTS: The mean age of patients was 72.5 (range 46-90), 50 male (62.5%) and mean Charlston Comorbidity Index of 5.1 (range 0-13). Mean follow-up time was 30.4 months (range 1-185.3) with median overall survival 109.2 months. Twenty-three patients (28.8%) with low grade tumors, treated with primary NU, had 2-, 5-, and 10-year OS of 100, 88, 73%. In contrast, 57 (71.3%) with high grade tumors had a lower 2-, 5-, and 10-year OS of 83, 68, 0%. Table 1 summarizes the oncologic outcomes based on histologic grade. Lymph node positive disease portends a particularly grim prognosis with 2and 5-year OS and CSS of 24 and 0% respectively CONCLUSIONS: Grade is a significant predictor of OS, CSS, and MFS in patients treated with nephroureterectomy for UTUC. Extirpative therapy was found to result in relatively poor long-term CSS in patients with high grade disease, underscoring the need for adjuvant or neoadjuvant therapies.