Which patients with upper tract urothelial carcinoma can be safely treated with flexible ureteroscopy with holmium:YAG laser photoablation?: long-term results from a high volume institution

Villa, Luca, Haddad, Mattieu, Capitanio, Umberto, Somani, Bhaskar K, Cloutier, Jonathan, Doizi, Steeve, Salonia, Andrea, Briganti, Alberto, Montorsi, Francesco and Traxer, Olivier (2018) Which patients with upper tract urothelial carcinoma can be safely treated with flexible ureteroscopy with holmium:YAG laser photoablation?: long-term results from a high volume institution. The Journal of Urology, 199 (1), 66-73. (doi:10.1016/j.juro.2017.07.088).

Abstract

PURPOSE: We tested the effects of tumor size, distribution and grade on progression-free survival in patients with upper tract urothelial carcinoma treated with flexible ureteroscopy with Ho:YAG laser photoablation.

MATERIALS AND METHODS: Included in analysis were data on 92 consecutive patients with upper tract urothelial carcinoma treated with Ho:YAG laser photoablation from 2003 to 2015 at a single tertiary care referral center. Stringent followup was offered according to EAU (European Association of Urology) guidelines. Progression during followup was defined by tumor upgrading, distant metastases and/or a relapsing tumor that could not be completely removed with a conservative approach. Kaplan-Meier curves were used to assess the rate of disease progression according to tumor size (1 or less cm vs greater than 1 cm), tumor distribution (unifocal vs multifocal) and tumor grade (low vs high). Cox regression analysis was done to test the impact of clinical and pathological characteristics on the rate of progression-free survival.

RESULTS: At a median followup of 52 months (IQR 27.8-76.4) the progression-free survival rate was 68% vs 72% in patients with a tumor size of 1 or less vs greater than 1 cm (p = 0.9), 72% vs 69% in patients with unifocal vs multifocal lesions (p = 0.6) and 75% vs 52% in patients with a low vs a high grade tumor (p = 0.03). On multivariable Cox regression analysis tumor grade at first treatment was the only independent predictor of disease progression (HR 5.16, 95% CI 1.19-22.26, p = 0.03).

CONCLUSIONS: High tumor grade independently decreased progression-free survival in patients with upper tract urothelial carcinoma treated with Ho:YAG laser photoablation. Tumor size greater than 1 cm and multifocality did not increase the risk of disease progression in patients treated conservatively with Ho:YAG laser photoablation.

This record has no associated files available for download.

Contributors

Download statistics