Poor Survival in Localized Upper Tract Urothelial Carcinoma Patients Treated Without Surgery

Patients with upper tract urothelial carcinoma (UTUC) who do not undergo definitive therapy have poorer outcomes than those who do, according to a new study. Fewer than 10% of UTUC patients are managed with such an approach.

“In general, the primary form of therapy for non-metastatic UTUC is surgery which is dictated by tumor location and includes either radical nephroureterectomy, segmental ureterectomy, or for select cases, endoscopic resection,” wrote study authors led by Jamil S. Syed, MD, of Yale School of Medicine in New Haven, Connecticut. “As the median age of diagnosis for UTUC is approximately 75 years, many patients may not be candidates for surgical management due to poor functional status or other comorbidities.”

The researchers set out to examine outcomes associated with non-definitive treatment, as little data is available in these patients. They identified 633 UTUC patients in the Surveillance, Epidemiology, and End Results database who did not receive surgery (7.6% of all patients with localized UTUC). Results of the analysis were published online ahead of print in BJU International.

Patients managed with non-definitive treatment were significantly older at diagnosis, with a median age of 81 years vs 71 years (P < .001). They also had smaller tumors, with a median size of 2.4 cm compared with 3 cm (P < .001), and were more commonly white (89.3%).

The median follow-up time for the non-definitive patients was 3.5 years, compared with 6.3 years in the surgical cohort. The median overall survival (OS) for non-definitive patients was 1.9 years, compared with 7.8 years in the surgically managed patients (P < .0001).

At 3 years, the disease-specific survival rate was 73.7% in the non-definitive patients, compared with 92.4% in those who underwent surgery (P < .0001). In patients in the non-definitive cohort with high-grade disease, the median OS was 1.5 years, compared with 3.4 years in those with low-grade disease (P < .0001).

There were several significant predictors of disease-specific mortality, including older age with a hazard ratio (HR) of 1.05 (P < .001), male sex with an HR of 0.716 (P = .045), and high tumor grade with an HR of 1.88 (P < .0001).

“Patients with localized UTUC who are managed non-operatively may exhibit extended survival in select cases,” the authors wrote. “These data may be helpful in counseling of patients who are poor surgical candidates with a short life expectancy and are considering a watchful waiting approach to management.”