Login to Access Video or Poster Abstract: MP78-17
Sources of Funding: none

Introduction

Evaluate the role of conservative endoscopic treatment (ET) in patients with high-risk upper tract urothelial carcinoma (UTUC)

Methods

42 out of 50 (84%) UTUC patients managed conservatively were included in prospective analysis from January 2011 to October 2016. Inclusion criteria were high-risk UTUC diagnosis (one or more high-risk EAU guidelines features), meanwhile exclusion criteria were pT1 or grade III biopsy in elective cases, invasive tumour aspect on CT-urography or previous radical cystectomy._x000D_ ET was performed both retrograde and anterograde access with rigid and digital flexible ureteroscope or percutaneous access. Endoscopic ablation was performed with Ho: YAG laser._x000D_ The variables analysed were: age, sex, history of bladder cancer, elective/imperative indication, hydronephrosis, urine cytology, tumour grade and stage, tumour size (?1cm/>1cm), tumour location and multifocality. Statistical analysis was performed using Chi square test or categorical variables. Overall Survival (OS) and Cancer Specific Survival (CSS) were calculated using Kaplan-Meier analysis. A p value <0.05 was considered to indicate statistical significance. SPSS 17.0 software was used_x000D_

Results

Elective and imperative indications occurred in 20 (47,6%) and 22 (52,4%) cases, respectively. Median age was 65 years (46-83) and 35 (70%) were male. Hydronephrosis on diagnosis was present in 17 (40,5%) and high-grade cytology in 4 cases (9,8%). Multifocality were in 21 (50%) and tumour size was >1cm in 23 (54,8%). Biopsies showed grade I in 23 (54,8%) and grade II in 17 (40,5%). Tumour stage was pTa in 37 (88%)._x000D_ ET was possible in 33 out of 42 (78,6%), where 17 (85%) were elective and 16 (72,7%) were imperative. Renal preservation was possible in 18 (94,7%) ?1cm tumours and in 15 (62,2%) >1cm, being tumour size the only predictive variable of renal preservation._x000D_ At 20 months (1-69) of follow up, recurrence was noted in 26 cases (61,9%) and grade progression in 6 (14,31%). The median OS was 51,8 months (42-61) and the median CSS was 56,7 months (47-65) with significant difference between imperative and elective cases. No death occurred in elective cases. Renal preservation survival (time until nephroureterectomy) was 42 months (33-51)._x000D_

Conclusions

According to our results, conservative endoscopic treatment should play a more important role in selected high-risk UTUC patients. It suggests a revision of the EAU guidelines recommendations

Funding

none