{"title":"Endoscopic Cryoablation Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma.","authors":"Yiling Chen, Chenyang Xu, Zezhong Mou, Yun Hu, Chen Yang, Jinzhong Hu, Xinan Chen, Jianfeng Luo, Lujia Zou, Haowen Jiang","doi":"10.1016/j.euo.2024.04.012","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objective: </strong>Cryoablation is a traditional antitumor therapy with good prospects for development. The efficacy of endoscopic management as a kidney-sparing surgery for high-risk upper tract urothelial carcinoma (UTUC) remains controversial. Our aim was to evaluate the impact of endoscopic cryoablation (ECA) versus radical nephroureterectomy (RNU) on survival outcomes, renal function, and complications.</p><p><strong>Methods: </strong>We retrospectively analyzed data for 116 patients with newly diagnosed high-risk UTUC who underwent either ECA (n = 13) or RNU (n = 103) from March 25, 2019 to December 8, 2021. Propensity score matching (1:4) using the nearest neighbor method was performed before analysis. The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), intravesical recurrence-free survival (RFS), the change in renal function, and treatment-emergent adverse events (TEAEs).</p><p><strong>Key findings and limitations: </strong>At median follow-up of 28.2 mo for the ECA group and 27.6 mo for the RNU group, 2-yr OS (82% vs 84%), PFS (73% vs 71%), and intravesical RFS (81% vs 83%) rates after matching did not significantly differ. A decline in renal function was observed after RNU, but not after ECA. Five (41.7%) patients in the ECA group reported six TEAEs, and 17 patients (35.4%) in the RNU group reported 20 TEAEs.</p><p><strong>Conclusions and clinical implications: </strong>In comparison to RNU, ECA for UTUC resulted in noninferior oncological outcomes and superior preservation of renal function.</p><p><strong>Patient summary: </strong>Our study suggests that a treatment called endoscopic cryoablation for high-risk cancer in the upper urinary tract can help in preserving kidney function, with similar survival outcomes to those after more extensive surgery. This option can be considered for selected patients with a strong preference for kidney preservation.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":null,"pages":null},"PeriodicalIF":8.3000,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European urology oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.euo.2024.04.012","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and objective: Cryoablation is a traditional antitumor therapy with good prospects for development. The efficacy of endoscopic management as a kidney-sparing surgery for high-risk upper tract urothelial carcinoma (UTUC) remains controversial. Our aim was to evaluate the impact of endoscopic cryoablation (ECA) versus radical nephroureterectomy (RNU) on survival outcomes, renal function, and complications.
Methods: We retrospectively analyzed data for 116 patients with newly diagnosed high-risk UTUC who underwent either ECA (n = 13) or RNU (n = 103) from March 25, 2019 to December 8, 2021. Propensity score matching (1:4) using the nearest neighbor method was performed before analysis. The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), intravesical recurrence-free survival (RFS), the change in renal function, and treatment-emergent adverse events (TEAEs).
Key findings and limitations: At median follow-up of 28.2 mo for the ECA group and 27.6 mo for the RNU group, 2-yr OS (82% vs 84%), PFS (73% vs 71%), and intravesical RFS (81% vs 83%) rates after matching did not significantly differ. A decline in renal function was observed after RNU, but not after ECA. Five (41.7%) patients in the ECA group reported six TEAEs, and 17 patients (35.4%) in the RNU group reported 20 TEAEs.
Conclusions and clinical implications: In comparison to RNU, ECA for UTUC resulted in noninferior oncological outcomes and superior preservation of renal function.
Patient summary: Our study suggests that a treatment called endoscopic cryoablation for high-risk cancer in the upper urinary tract can help in preserving kidney function, with similar survival outcomes to those after more extensive surgery. This option can be considered for selected patients with a strong preference for kidney preservation.
背景和目的：冷冻消融术是一种传统的抗肿瘤疗法，具有良好的发展前景。对于高危的上尿路上皮癌（UTUC），内镜治疗作为保肾手术的疗效仍存在争议。我们的目的是评估内镜下冷冻消融术（ECA）与根治性肾切除术（RNU）对生存结果、肾功能和并发症的影响：我们回顾性分析了2019年3月25日至2021年12月8日期间接受ECA（13例）或RNU（103例）治疗的116例新确诊高危UTUC患者的数据。分析前采用近邻法进行倾向得分匹配（1:4）。主要结果是总生存期（OS）。次要结局包括无进展生存期（PFS）、无膀胱内复发生存期（RFS）、肾功能变化以及治疗突发不良事件（TEAEs）：ECA组和RNU组的中位随访时间分别为28.2个月和27.6个月，匹配后的2年OS（82% vs 84%）、PFS（73% vs 71%）和膀胱内无复发生存率（81% vs 83%）无显著差异。RNU 后观察到肾功能下降，而 ECA 后没有观察到肾功能下降。ECA组有5名患者（41.7%）报告了6例TEAE，RNU组有17名患者（35.4%）报告了20例TEAE：患者总结：我们的研究表明，内镜下冷冻消融治疗上尿路高危癌症有助于保留肾功能，其生存结果与更广泛手术后的结果相似。对于选择保留肾脏的患者，可以考虑采用这种方法。
期刊介绍：
Journal Name: European Urology Oncology
Affiliation: Official Journal of the European Association of Urology
Focus:
First official publication of the EAU fully devoted to the study of genitourinary malignancies
Aims to deliver high-quality research
Content:
Includes original articles, opinion piece editorials, and invited reviews
Covers clinical, basic, and translational research
Publication Frequency: Six times a year in electronic format
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