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UPJ INSIGHT Changes in the Perioperative Management and Outcomes of Patients With Upper Tract Urothelial Carcinoma
By: Wesley Yip, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Melissa J. Assel, MS, Memorial Sloan Kettering Cancer Center, New York, New York; Nathan C. Wong, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Andrew T. Tracey, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Ricardo G. Alvim, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Lucas Nogueira, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Nima Almassi, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Nirmish Singla, MD, MSc, Memorial Sloan Kettering Cancer Center, New York, New York; Timothy N. Clinton, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Daniel D. Sjoberg, MA, Memorial Sloan Kettering Cancer Center, New York, New York; Hikmat Al-Ahmadie, MD, Memorial Sloan Kettering Cancer Center, New York, New York; A. Ari Hakimi, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Eugene J. Pietzak, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Eugene K. Cha, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Timothy F. Donahue, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Guido Dalbagni, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Bernard H. Bochner, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Dean F. Bajorin, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Jonathan A. Coleman, MD, Memorial Sloan Kettering Cancer Center, New York, New York | Posted on: 18 Mar 2024
Yip W, Assel MJ, Wong NC, et al. Changes in the perioperative management and outcomes of patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy at Memorial Sloan Kettering Cancer Center: over 20 years of experience. Urol Pract. 2024;11(2):356-366.
Study Need and Importance
Upper tract urothelial carcinoma (UTUC) is a rare disease with limited data on treatment paradigms, which are necessary for the development of standardized strategies to care for these patients. Thus, our goal was to evaluate trends in perioperative and surgical management of patients who underwent radical nephroureterectomy for UTUC at our institution over a 24-year period to estimate changes in care strategies and oncologic outcomes.
What We Found
Our study found several changes in treatment patterns and outcomes for these patients, including a decrease in the proportion of low-grade disease being treated with radical nephroureterectomy and an increase in the usage of endoscopic biopsy for risk stratification. There was also an increase in the usage of neoadjuvant chemotherapy and minimally invasive surgery (Figure), as well as lymph node dissection. Cancer-specific survival and cancer-specific survival after recurrence increased, but metastasis-free and overall survival were stable.
Limitations
Our study is limited by its retrospective single-institution design, with relatively short median follow-up due to referral patterns. Treatment options were not standardized across the institution, with potential selection and surgeon biases.
Interpretation for Patient Care
UTUC is a rare disease to manage, but in the modern era, risk stratification with endoscopic biopsy has increased in frequency while extirpative surgery for low-grade disease has decreased. In those who are undergoing radical surgery, neoadjuvant chemotherapy, minimally invasive techniques, and lymph node dissections have become more common.
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