Outcome of Non-Muscle Invasive Upper Tract Urothelial Carcinoma Receiving Endoscopic Ablation: An Inverse Probability of Treatment Weighting Analysis.

Chih-Yu Shen,Tzong-Shin Tzai,Wei-Chih Kan,Yuh-Shyan Tsai,Yeong-Chin Jou

doi:10.3390/jcm11051307

Abstract

We compared the outcomes in early-stage upper tract urothelial carcinoma (UTUC) patients receiving endoscopic ablation (EA) with radical nephroureterectomy (RNU). From 2004 to 2018, cTa/T1N0M0 UTUC patients undergoing EA and RNU were enrolled. For reducing observational bias, propensity scores based on inverse probability of treatment weighting (IPTW) were utilized for comparing the oncologic outcomes and renal function changes. In total, 65 of 184 cTa/T1 UTUC patients were analyzed after exclusion of 119 patients with end-stage renal disease, and lack of previous ureteroscopic biopsy. The studied patients included 23 who received EA and 42 RNU, and both groups were well balanced after adjusting with IPTW. The median follow-up period was 43.6 months. There was no statistical difference between the two groups in terms of oncological outcome. The EA group exhibited less estimated glomerular filtration rate (eGFR) decline one year later (0.0% vs. 20.2%, p < 0.001) and less worsening of chronic kidney status (13.2% vs. 46.5%, p = 0.026). Among patients receiving EA, high-grade tumors exhibited higher subsequent recurrence in the residual urinary tract than did the low-grade ones. (p = 0.037). In summary, endoscopic ablation preserves renal function without compromising oncological outcome in selected UTUC patients. High-grade tumors should be strictly followed up following endoscopic ablation.

Highlights

Upper tract urothelial carcinoma (UTUC) is an uncommon genitourinary malignancy and accounts for 5–10% of all urothelial malignancies in western countries [1]
We demonstrated that endoscopic ablation can preserve renal function without compromising oncological outcome in selected non-invasive, both lowand high-grade, upper tract urothelial carcinoma (UTUC) patients, which was strengthened by using an inverse probability of treatment weighting analysis
There were 119 patients excluded from this study, including those with muscleinvasive disease, end stage renal disease (ESRD), receiving other types of KSS, without ureteroscopic biopsy, and without subsequent definite therapy

Summary

Introduction

Upper tract urothelial carcinoma (UTUC) is an uncommon genitourinary malignancy and accounts for 5–10% of all urothelial malignancies in western countries [1]. There were several known etiologies associated with UTUC, including chronic arsenic exposure [3], Chinese herb nephropathy [4], or Balkan nephropathy [4] The latter two were reported to be associated with Aristolochic acid exposure and chronic kidney disease [4]. Some patients or urologists may hesitate in undergoing nephroureterectomy because of the higher incidence of subsequent deterioration of renal function following the loss of one renal unit, for those with potential progression to end-stage renal diseases (i.e., diabetics, patients with chronic kidney disease, patients with Aristolochic acid exposure), or not benefit those scheduled for post-operative chemotherapy. It is necessary to undertake a reappraisal of the role of endoscopic ablation as a definite therapy for UTUC in the current circumstances, for those high-grade, non-invasive patients

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