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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

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
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

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.

Journal Article
0022-5347
66-73
Villa, Luca
9e9b5408-8139-4210-968b-41ef854f701a
Haddad, Mattieu
72e2599d-5829-4751-bc79-d185f23f536f
Capitanio, Umberto
e463c556-d1a9-4670-932f-40edf0c18acd
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Cloutier, Jonathan
a9095c1c-c11a-4a2a-ad08-723431c52a30
Doizi, Steeve
78d0331b-2eee-459b-97bd-8e728868211e
Salonia, Andrea
e3a726a3-a34a-4ab7-a56e-02e9bf908dbb
Briganti, Alberto
1cf45743-29e8-4188-8ecc-3912262584aa
Montorsi, Francesco
a03d6276-2672-4e06-b3ae-1917f66ed16b
Traxer, Olivier
2fa78817-b6f8-4f00-b389-c9c9ddbd01f3
Villa, Luca
9e9b5408-8139-4210-968b-41ef854f701a
Haddad, Mattieu
72e2599d-5829-4751-bc79-d185f23f536f
Capitanio, Umberto
e463c556-d1a9-4670-932f-40edf0c18acd
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Cloutier, Jonathan
a9095c1c-c11a-4a2a-ad08-723431c52a30
Doizi, Steeve
78d0331b-2eee-459b-97bd-8e728868211e
Salonia, Andrea
e3a726a3-a34a-4ab7-a56e-02e9bf908dbb
Briganti, Alberto
1cf45743-29e8-4188-8ecc-3912262584aa
Montorsi, Francesco
a03d6276-2672-4e06-b3ae-1917f66ed16b
Traxer, Olivier
2fa78817-b6f8-4f00-b389-c9c9ddbd01f3

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).

Record type: Article

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.

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More information

Accepted/In Press date: 25 July 2017
e-pub ahead of print date: 14 August 2017
Published date: 1 January 2018
Additional Information: Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Keywords: Journal Article

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Local EPrints ID: 419161
URI: http://eprints.soton.ac.uk/id/eprint/419161
ISSN: 0022-5347
PURE UUID: 0cbf587c-6acd-4d74-8687-ed5ad5c3b816

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Date deposited: 06 Apr 2018 16:30
Last modified: 13 Mar 2019 18:44

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Contributors

Author: Luca Villa
Author: Mattieu Haddad
Author: Umberto Capitanio
Author: Jonathan Cloutier
Author: Steeve Doizi
Author: Andrea Salonia
Author: Alberto Briganti
Author: Francesco Montorsi
Author: Olivier Traxer

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