PMID- 37525448 OWN - NLM STAT- MEDLINE DCOM- 20231023 LR - 20231023 IS - 0219-3108 (Electronic) IS - 1015-9584 (Linking) VI - 46 IP - 8 DP - 2023 Aug TI - Endoscopic management of upper tract urothelial cancer in a highly endemic area: A Taiwan nationwide collaborative study. PG - 3058-3065 LID - S1015-9584(22)01471-3 [pii] LID - 10.1016/j.asjsur.2022.10.046 [doi] AB - BACKGROUND: Endoscopic management of upper tract urothelial cancer (UTUC) is an important treatment option for low risk UTUC. Although Taiwan is an endemic area for UTUC, endoscopic treatment outcomes in Taiwan are frequently under- reported. METHODS: This study retrospectively reviewed the treatment outcomes of endoscopic management for clinically localized UTUC. Patients with biopsy or washing cytology confirmed UTUC who underwent endoscopic or percutaneous management with a curative intent were retrospectively reviewed for eligibility of analysis. Those cases without pre-intervention confirmed UTUC, and metastatic or nodal disease at diagnosis were excluded. RESULTS: In total, 307 patients who underwent endoscopic management were reviewed and 279 cases were eligible for final analysis. With a median follow-up of 44.3 months (inter-quartile range (IQR): 23.4-76.4 months), 117 cases (46.4%) were endoscopic cured after median one session (range:1-8; IQR:1-2) of endoscopic treatment. Those endoscopic cured UTUC was associated with more small-sized tumor, more low-grade biopsied-histology, less concomitant bladder UC and less pre-operative hydronephrosis. In addition, 201(79.7%) cases among 252 cases with confirmed oncological outcome were free of UTUC at the end of follow-up and only 43 (17%) patients had a UTUC related mortality. Salvage RNU offered a better tumor free survival rate (92% vs. 77.5%) than those without salvage RNU in those UTUC refractory to endoscopic management. In multivariable analyses, pre-operative hydronephrosis was the independent risk factor for OS. Multiplicity and concomitant bladder UC were independent risk factors for DFS. CONCLUSIONS: We confirmed the consistent safety and efficacy of endoscopic management of clinical localized UTUC in a highly UTUC endemic area like Taiwan. Early salvage RNU is mandatory in those UTUC refractory to endoscopic management in prevention of UTUC related death. CI - Copyright (c) 2023 Asian Surgical Association and Taiwan Robotic Surgery Association. Published by Elsevier B.V. All rights reserved. FAU - Chen, Yung Tai AU - Chen YT AD - Department of Urology, Postal Hospital, Taipei, Taiwan; Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan. FAU - Yeh, Hsin-Chih AU - Yeh HC AD - Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan. FAU - Lee, Hsiang-Ying AU - Lee HY AD - Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan. FAU - Hsieh, Po-Fan AU - Hsieh PF AD - Department of Urology, China Medical University Hospital, Taichung, 40447, Taiwan; School of Medicine, China Medical University, Taichung, 40402, Taiwan; Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, 40402, Taiwan. FAU - Chou, Eric Chieh-Lung AU - Chou EC AD - Department of Urology, China Medical University Hospital, Taichung, 40447, Taiwan; School of Medicine, China Medical University, Taichung, 40402, Taiwan; Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, 40402, Taiwan. FAU - Tsai, Yao-Chou AU - Tsai YC AD - Division of Urology, Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan. Electronic address: tsai1970523@yahoo.com.tw. FAU - Hong, Jian-Hua AU - Hong JH AD - Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. FAU - Huang, Chao-Yuan AU - Huang CY AD - Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. FAU - Jiang, Yuan-Hong AU - Jiang YH AD - Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan. FAU - Lee, Yu-Khun AU - Lee YK AD - Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan. FAU - Tseng, Jen-Shu AU - Tseng JS AD - Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252, Taiwan; Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan No.155, Sec.2, Linong Street, Taipei, 112, Taiwan. FAU - Yu, Chih-Chin AU - Yu CC AD - Division of Urology, Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan. FAU - Chiang, Bing-Juin AU - Chiang BJ AD - College of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan; Department of Urology, Cardinal Tien Hospital, New Taipei City, 23148, Taiwan; Department of Life Science, College of Science, National Taiwan Normal University, Taipei, 11677, Taiwan. FAU - Hsueh, Thomas Y AU - Hsueh TY AD - Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taiwan; Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. FAU - Wu, Chia-Chang AU - Wu CC AD - Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. FAU - Tsai, Chung-You AU - Tsai CY AD - Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Taiwan; Department of Healthcare Information＆Management, Ming Chuan University, Taiwan. LA - eng PT - Journal Article DEP - 20221029 PL - Netherlands TA - Asian J Surg JT - Asian journal of surgery JID - 8900600 SB - IM MH - Humans MH - Ureteroscopy MH - *Ureteral Neoplasms/surgery/pathology MH - Taiwan/epidemiology MH - Retrospective Studies MH - *Urinary Bladder Neoplasms MH - *Carcinoma, Transitional Cell/surgery/pathology MH - *Hydronephrosis OTO - NOTNLM OT - Endoscopic management OT - Nephroureterectomy OT - Upper urinary tract urothelial cancer OT - Ureteroscopy COIS- Declaration of competing interest Yung Tai Chen, Hsin-Chih Yeh, Hsiang-Ying Lee, Po-Fan Hsieh, Eric Chieh-lung Chou, Yao-Chou Tsai, Ting-En Tai, Jian-Hua Hong, Chao-Yuan Huang, Yuan-Hong Jiang, Yu-Khun Lee, Jen-Shu Tseng, Chih-Chin Yu, Bing-Juin Chiang, Thomas Y. Hsueh, Chia-Chang Wu, and Chung-You Tsai have no conflicts of interest or financial ties to disclose. EDAT- 2023/08/01 06:45 MHDA- 2023/10/23 00:43 CRDT- 2023/08/01 01:17 PHST- 2022/02/22 00:00 [received] PHST- 2022/06/25 00:00 [revised] PHST- 2022/10/13 00:00 [accepted] PHST- 2023/10/23 00:43 [medline] PHST- 2023/08/01 06:45 [pubmed] PHST- 2023/08/01 01:17 [entrez] AID - S1015-9584(22)01471-3 [pii] AID - 10.1016/j.asjsur.2022.10.046 [doi] PST - ppublish SO - Asian J Surg. 2023 Aug;46(8):3058-3065. doi: 10.1016/j.asjsur.2022.10.046. Epub 2022 Oct 29.