Upper tract urothelial carcinoma (UTUC) is rare and its management presents many challenges. Outside of distal ureterectomy for select cases, management has been primarily radical nephroureterectomy. Endoscopic nephron sparing management (NSM) is recognized to have some role in UTUC treatment; however, it is yet to gain firm footing in the treatment algorithm. In this review, we discuss the benefits of NSM with regards to oncologic outcomes, renal function preservation, and cost savings. Finally, we propose recognition of endoscopic NSM as a first-line treatment in selected patients with low risk disease.
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References
1.
RoupretM, BabjukM, ComperatE, et al.European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol, 2013; 63:1059–1071.
2.
YamanyT, van BataviaJ, AhnJ, ShapiroE, GuptaM. Ureterorenoscopy for upper tract urothelial carcinoma: How often are we missing lesions?. Urology, 2015; 85:311–315.
3.
SmithAK, StephensonAJ, LaneBR, et al.Inadequacy of biopsy for diagnosis of upper tract urothelial carcinoma: Implications for conservative management. Urology, 2011; 78:82–86.
4.
BrownGA, MatinSF, BusbyJE, et al.Ability of clinical grade to predict final pathologic stage in upper urinary tract transitional cell carcinoma: Implications for therapy. Urology, 2007; 70:252–256.
5.
KeeleyFX, KulpDA, BibboM, McCuePA, BagleyDH. Diagnostic accuracy of ureteroscopic biopsy in upper tract transitional cell carcinoma. J Urol, 1997; 157:33–37.
6.
DeligneE, ColombelM, BadetL, et al.Conservative management of upper urinary tract tumors. Eur Urol, 2002; 42:43–48.
7.
IborraI, SolsonaE, CasanovaJ, RicosJV, RubioJ, ClimentMA. Conservative elective treatment of upper urinary tract tumors: A multivariate analysis of prognostic factors for recurrence and progression. J Urol, 2003; 169:82–85.
8.
MilnerJE, VoelzkeBB, FlaniganRC, SharmaSK, PerryKT, TurkTM. Urothelial-cell carcinoma and solitary kidney: Outcomes with renal-sparing management. J Endourol, 2006; 20:800–807.
9.
RoupretM, HupertanV, TraxerO, et al.Comparison of open nephroureterectomy and ureteroscopic and percutaneous management of upper urinary tract transitional cell carcinoma. Urology, 2006; 67:1181–1187.
SowterSJ, IlieCP, EfthimiouI, TolleyDA. Endourologic management of patients with upper-tract transitional-cell carcinoma: Long-term follow-up in a single center. J Endourol, 2007; 21:1005–1009.
12.
LucasSM, SvatekRS, OlginG, et al.Conservative management in selected patients with upper tract urothelial carcinoma compares favourably with early radical surgery. BJU Int, 2008; 102:172–176.
13.
ThompsonRH, KrambeckAE, LohseCM, ElliottDS, PattersonDE, BluteML. Endoscopic management of upper tract transitional cell carcinoma in patients with normal contralateral kidneys. Urology, 2008; 71:713–717.
14.
GadzinskiAJ, RobertsWW, FaerberGJ, WolfJSJr. Long-term outcomes of nephroureterectomy versus endoscopic management for upper tract urothelial carcinoma. J Urol, 2010; 183:2148–2153.
15.
CutressML, StewartGD, TudorEC, et al.Endoscopic versus laparoscopic management of noninvasive upper tract urothelial carcinoma: 20-year single center experience. J Urol, 2013; 189:2054–2060.
16.
FajkovicH, KlatteT, NageleU, et al.Results and outcomes after endoscopic treatment of upper urinary tract carcinoma: The Austrian experience. World J Urol, 2013; 31:37–44.
17.
MotamediniaP, KeheilaM, LeavittDA, RastinehadAR, OkekeZ, SmithAD. The expanded use of percutaneous resection for upper tract urothelial carcinoma: A 30-year comprehensive experience. J Endourol, 2015; 30:262–267.
18.
RoupretM, ColinP, YatesDR. A new proposal to risk stratify urothelial carcinomas of the upper urinary tract (UTUCs) in a predefinitive treatment setting: Low-risk versus high-risk UTUCs. Eur Urol, 2014; 66:181–183.
19.
LeeBR, JabbourME, MarshallFF, SmithAD, JarrettTW. 13-Year survival comparison of percutaneous and open nephroureterectomy approaches for management of transitional cell carcinoma of renal collecting system: Equivalent outcomes. J Endourol, 1999; 13:289–294.
20.
GrassoM, FishmanAI, CohenJ, AlexanderB. Ureteroscopic and extirpative treatment of upper urinary tract urothelial carcinoma: A 15-year comprehensive review of 160 consecutive patients. BJU Int, 2012; 110:1618–1626.
21.
YakoubiR, ColinP, SeisenT, et al.Radical nephroureterectomy versus endoscopic procedures for the treatment of localised upper tract urothelial carcinoma: A meta-analysis and a systematic review of current evidence from comparative studies. Eur J Surg Oncol, 2014; 40:1629–1634.
HoffmanA, YossepowitchO, ErlichY, HollandR, LifshitzD. Oncologic results of nephron sparing endoscopic approach for upper tract low grade transitional cell carcinoma in comparison to nephroureterectomy - a case control study. BMC Urol, 2014; 14:97.
24.
SimhanJ, SmaldoneMC, EglestonBL, et al.Nephron-sparing management vs radical nephroureterectomy for low- or moderate-grade, low-stage upper tract urothelial carcinoma. BJU Int, 2014; 114:216–220.
WeizerAZ, FaerberGJ, WolfJSJr. Progression of disease despite good endoscopic local control of upper tract urothelial carcinoma. Urology, 2007; 70:469–472.
27.
GadzinskiAJ, RobertsWW, FaerberGJ, WolfJSJr. Long-term outcomes of immediate versus delayed nephroureterectomy for upper tract urothelial carcinoma. J Endourol, 2012; 26:566–573.
28.
HuangWC, LeveyAS, SerioAM, et al.Chronic kidney disease after nephrectomy in patients with renal cortical tumours: A retrospective cohort study. Lancet Oncol, 2006; 7:735–740.
29.
RamanJD, LinYK, KaagM, et al.High rates of advanced disease, complications, and decline of renal function after radical nephroureterectomy. Urol Oncol, 2014; 32:47:e9–e14.
30.
XylinasE, RinkM, MargulisV, et al.Impact of renal function on eligibility for chemotherapy and survival in patients who have undergone radical nephro-ureterectomy. BJU Int, 2013; 112:453–461.
31.
KaagMG, O'MalleyRL, O'MalleyP, et al.Changes in renal function following nephroureterectomy may affect the use of perioperative chemotherapy. Eur Urol, 2010; 58:581–587.
32.
GoAS, ChertowGM, FanD, McCullochCE, HsuCY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med, 2004; 351:1296–1305.
33.
ChenCY, LiaoYM, TsaiWM, KuoHC. Upper urinary tract urothelial carcinoma in eastern Taiwan: High proportion among all urothelial carcinomas and correlation with chronic kidney disease. J Formos Med Assoc, 2007; 106:992–998.
34.
ChungSD, HuangKH, LaiMK, et al.CKD as a risk factor for bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. Am J Kidney Dis, 2007; 50:743–753.
35.
WatsonP, VasenHF, MecklinJP, et al.The risk of extra-colonic, extra-endometrial cancer in the Lynch syndrome. Int J Cancer, 2008; 123:444–449.
ChurchillDN, TorranceGW, TaylorDW, et al.Measurement of quality of life in end-stage renal disease: The time trade-off approach. Clin Invest Med, 1987; 10:14–20.
38.
HuboskySG, BomanBM, CharlesS, BibboM, BagleyDH. Ureteroscopic management of upper tract urothelial carcinoma (UTUC) in patients with Lynch Syndrome (hereditary nonpolyposis colorectal cancer syndrome). BJU Int, 2013; 112:813–819.
39.
PakRW, MoskowitzEJ, BagleyDH. What is the cost of maintaining a kidney in upper-tract transitional-cell carcinoma? An objective analysis of cost and survival. J Endourol, 2009; 23:341–346.
40.
KlinghofferZ, TarrideJE, NovaraG, et al.Cost-utility analysis of radical nephrectomy versus partial nephrectomy in the management of small renal masses: Adjusting for the burden of ensuing chronic kidney disease. Can Urol Assoc J, 2013; 7:108–113.
41.
SeisenT, ColinP, RoupretM. Risk-adapted strategy for the kidney-sparing management of upper tract tumours. Nat Rev Urol, 2015; 12:155–166.
