Surveillance Versus Nephroureterectomy for Patients With Large-Volume, Low-Grade UC

A study from Guy Verhovsky, MD, and colleagues presented at the European Association of Urology (EAU) Congress 2024 evaluated the data of patients with large-volume, low-grade urothelial carcinoma (LV-LGUC) who received treatment endoscopically versus those who underwent extirpative surgery.

The retrospective analysis compared the demographic, clinical, and pathological data from patients who received conservative management (Group 1) versus those who underwent nephroureterectomy (Group 2) over a 20-year follow-up period. Researchers assessed recurrence rates, overall survival (OS), and disease progression.

Of the 160 patients diagnosed with UTUC during the study’s timeframe, 45 (28.12%) had LV-LGUC, 17 (37.50%) received endoscopic treatment, and 9 (53.00%) had a solitary kidney. The median age in the 2 cohorts was 70.2 years and 74.1 years, respectively, while the median follow-up period was 16.8 years and 11.2 years (P<.01).

Patients in Group 1 underwent more ureteroscopy procedures (10.2) than those in Group 2 (6.1). In Groups 1 and 2, the OS rates were 92%, 81%, 41%, and 9%, compared with 91%, 84%, 51%, and 17% at 5, 10, 15, and 20 years, respectively (P=.08). In Group 1, metastatic-free survival rates were 96%, 76%, 71%, and 41%, while Group 2 experienced rates of 93%, 87%, and 68% (P=.02).

During the 20-year follow-up, 52% of patients in Group 1 progressed to high-grade disease.

Dr. Verhovsky and colleagues concluded that patients with LV-LGUC who were treated endoscopically underwent more ureteroscopy procedures and experienced increased metastasis as well as decreased OS rates. They noted that their results agreed with current EAU and American Urological Association guidelines labeling LV-LGUC a high-risk disease and recommending patients receive extirpative therapy.

“The use of a minimally invasive approach to LV-LGUC, while technically feasible, bears significant oncologic consequences,” the researchers wrote. “Future research on molecular markers, such as PD-L1, may help differentiate this unique subset of patients.”