Princess Margaret Cancer Centre, University of Toronto, University Health Network
Introduction: The use of endoscopic techniques for the management of Upper Tract Urothelial Carcinoma (UTUC) has increased over time. Disease recurrence remains a central consideration following therapy. Here, we query a large database of endoscopic UTUC procedures to determine factors associated with overall survival. Methods: A multi-centric database of 6 institutions was compiled to assess outcomes and characteristics of patients who underwent endoscopic management for UTUC. Cox Regression analysis determined factors associated with overall survival among this population of patients. Results: A total of 392 endoscopic treatments for UTUC performed in 215 individual patients was included. Mean age was 73.5 years old, Charlson score was 5.37 and 60% were male. 61% had a smoking history, 55% had a history of bladder cancer and 4.3% had a history of cystectomy. 6% of the patients had bilateral UTUC and 57% had lesions larger than 1 cm, while 16.5% were high grade tumors. 46% of the endoscopic treatments were considered “imperative”, defined as solitary kidney or non-surgical candidates. The lesion was multifocal in 45% of the cases and cytology was positive approximately 10%. Intracavitary treatment for UTUC was used in 30% of the endoscopic treatments. Recurrence after treatment was found in 57.9%, and 14.5% underwent nephroureterectomy. 97 patients died at a mean follow-up of 33 months. Cox regression analysis found that the single independent predictor for mortality was recurrence (HR 2.27, 95% CI 1.29 – 4.00, p= 0.004). Conclusions: The present information suggests that regardless of the patient characteristics, recurrence of urothelial disease is the main determinant of survival among patients with UTUC treated with endoscopic techniques. SOURCE OF Funding: None
