Data about the mid- and long-term oncologic outcomes of endoscopic kidney-sparing surgery (eKSS) for upper tract urothelial carcinoma (UTUC) are scarce. Therefore, we aimed to summarize the current evidence on the oncologic outcomes of eKSS for UTUC.
A literature search was conducted to identify reports published until May 2024. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The outcomes were the following: recurrence-free (RFS), intravesical recurrence-free (IV-RFS), progression-free (PFS), cancer-specific (CSS), and overall (OS) survival.
We found 56 studies (n = 52 retrospective) that met our inclusion criteria (n = 2862 patients). The 1-, 2-, 5-, and 10-yr OS rates were 96%, 87%, 80%, and 42%, respectively. The 1-, 2-, 5-, and 10-yr CSS rates were 97%, 89%, 82%, and 69%, respectively. RFS rates at 1, 2, and 5 yr were 69%, 55%, and 45%, respectively. IV-RFS rates at 1, 2, and 5 yr were 80%, 65%, and 64%, respectively. PFS rates at 2 and 5 yr were 75% and 69%, respectively. In low-grade UTUC, OS rates at 2 and 5 yr were 93% and 77%, respectively. The 2- and 5-yr CSS rates were 98% and 88%, respectively. At 2 yr, RFS, IV-RFS, and PFS were 52%, 54%, and 94%, respectively. For high-grade UTUC, only three studies reported data on 2-yr RFS, which was 34%. The main limitation is the heterogeneity found across the studies.
Local recurrence, bladder recurrence, and progression of UTUC occur mainly within 2 yr after eKSS. After 5-yr follow-up, OS and CSS drop, while the risk of local recurrence is non-negligible.
European urology focus. 2025 Feb 01 [Epub ahead of print]
Andrea Gallioli, Alessandro Uleri, Paolo Verri, Alessandro Tedde, Laura S Mertens, Marco Moschini, Francesco Del Giudice, Francesco Soria, Ekaterina Laukhtina, José Daniel Subiela, Wojciech Krajewski, David D'Andrea, Andrea Mari, Gautier Marcq, Keiichiro Mori, Jeremy Teoh, Luca Afferi, Simone Albisinni, Francesco Sanguedolce, Joan Palou, Alberto Breda, Benjamin Pradere, EAU-YAU Urothelial Working Group
Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: ., Department of Urology, Fundació Puigvert, Barcelona, Spain., Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Medicine, Surgery and Pharmacy, Università degli Studi di Sassari, Sassari, Italy., Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy., Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy., Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy., Department of Urology, Comprehensive Cancer Center and Medical University of Vienna, Vienna, Austria., Department of Urology, Hospital Universitario Ramón y Cajal IRYCIS Universidad de Alcalá, Madrid, Spain., Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland., Urological Robotic Surgery and Renal Transplantation, University of Florence and Careggi Hospital, Florence, Italy., Department of Urology, Claude Huriez Hospital, Lille, France., Department of Urology, The Jikei University School of Medicine, Tokyo, Japan., Surgery, S.H. Ho Urology Centre and The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland., Unit of Urology, Department of Surgical Sciences, Tor Vergata University, Rome, Italy., Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain., Department of Urology, Urosud La Croix du Sud Hospital, Quint Fonsegrives, France.