Open Access

ARTICLE

Outcomes of upper tract urothelial cancer managed non-surgically

Jamil S. Syed¹, Kevin A. Nguyen¹, Alfie Suarez-Sariemento¹, Cynthia Leung¹, Marianne Casilla-Lennon¹, Jay D. Raman², Brian Shuch^1,3

1 Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
2 Division of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
3 Department of Urology, Institute of Urologic Oncology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
Address correspondence to Dr. Brian Shuch, Department of Urology, Yale School of Medicine, PO Box 208058 New Haven, CT 06520-8058 USA

Canadian Journal of Urology 2019, 26(2), 9699-9707.

Abstract

Introduction: Approximately 7% of patients with localized upper tract urothelial cancer (UTUC) are treated without definitive therapy. Understanding outcomes and alternative therapy would aid in counseling older patients with comorbidities.
Materials and methods: We utilized the National Cancer Database to identify patients with localized UTUC managed non-surgically between 2004 and 2013. Patient demographics, comorbidity, tumor grade, and chemotherapy and radiation utilization were recorded. Survival analyses were performed with the Kaplan-Meier method and a Cox proportional hazard regression model.
Results: We identified 3157 (10.9%) patients with localized UTUC who did not receive definitive surgery. Median age was 79 years, 55% were males, 79% had government health insurance, and 68% had a Charlson-Deyo Score (CDS) of 0. Tumor grade was low (grade 1 or 2) in 632 (36.4%) and high (grade 3 or 4) in 1104 (63.6%). Median overall survival (OS) for the cohort was 2.2 years, significantly shorter for patients with greater comorbidities. Chemotherapy or radiation was performed in 294 (9.3%) and 197 (6.3%) patients respectively. There were no OS differences for individuals receiving chemotherapy. Of patients who received radiation therapy, the median OS was 1.4 versus 2.0 years, (p < 0.001) favoring no radiation. Those with high grade tumors had worse survival (1.9 versus 3.8 years, p < 0.001). Significant predictors of shorter OS included older age, male gender, higher CDS, and government insurance.
Conclusions: In this population-based cohort, 10.9% of patients with localized UTUC were managed non-surgically. There was no OS advantage noted in cohorts receiving chemotherapy and radiation therapy. Median OS was significantly shorter for those with higher grade disease, increasing comorbidity profile, male gender, and those with government insurance status.

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