Adjuvant Single-Dose Upper Urinary Tract Instillation of Mitomycin C After Therapeutic Ureteroscopy for Upper Tract Urothelial Carcinoma: A Single-Centre Prospective Non-Randomized Trial
Por:
Gallioli, A, Boissier, R, Territo, A, Reyes, HV, Sanguedolce, F, Gaya, JM, Regis, F, Subiela, JD, Palou, J, Breda, A
Publicada:
1 may 2020
Ahead of Print:
1 abr 2020
Resumen:
Purpose: To address the safety and feasibility of adjuvant single-dose upper urinary tract instillation of mitomycin (ASDM) immediately after therapeutic ureteroscopy for upper tract urothelial carcinoma (UTUC) and to compare urothelial (ipsilateral or bladder) recurrence rates in the ASDM group and controls.
Materials and Methods: Between April 2015 and August 2018, 52 patients affected by UTUC were treated by endoscopic ablation, of whom 26 were selected for ASDM. Clinical and perioperative data and 30-day complications were recorded. Urothelial recurrence-free survival (URFS) was evaluated with second-look ureteroscopy (URS) and CT scan/URS every 6 months.
Results: ASDM was administered through a Single-J (19/25, 76%) or a Double-J (6/25, 24%) in 25/26 (96%) patients. Median follow-up was 18 months (IQR 10-29). The urothelial recurrence rate was 23.5% and 55.5% in the ASDM group and controls, respectively (p = 0.086). Mean URFS was 28.8 months in the ASDM group vs 18.8 months in controls (log-rank p = 0.067). On multivariate Cox regression, ASDM was associated with a 7.7-fold lower risk of urothelial recurrence (HR = 0.13; 95% CI 0.03-0.65; p = 0.01). Clavien grade <= II complications occurred in 32% (8/25) and 30.7% (8/26) of the ASDM and control group, respectively (p = 0.9). Two Clavien III complications occurred in the ASDM group: bladder hematuria after concomitant transurethral resection of bladder and obstructive kidney failure in a single-kidney patient.
Conclusions: ASDM was well tolerated after therapeutic URS. It appears to reduce the risk of urothelial recurrence in patients affected by low-grade UTUC without bladder tumor. Therefore, its use should be evaluated.
Filiaciones:
Gallioli, A:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Cartagena 340-350, Barcelona 08025, Spain
Univ Milan, Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Clin Sci & Community Hlth, Urol, Milan, Italy
Boissier, R:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Cartagena 340-350, Barcelona 08025, Spain
Aix Marseille Univ, La Conception Acad Hosp, AP HM, Dept Urol, Marseille, France
Territo, A:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Cartagena 340-350, Barcelona 08025, Spain
Reyes, HV:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Cartagena 340-350, Barcelona 08025, Spain
Sanguedolce, F:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Cartagena 340-350, Barcelona 08025, Spain
Gaya, JM:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Cartagena 340-350, Barcelona 08025, Spain
Regis, F:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Cartagena 340-350, Barcelona 08025, Spain
Subiela, JD:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Cartagena 340-350, Barcelona 08025, Spain
Palou, J:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Cartagena 340-350, Barcelona 08025, Spain
Breda, A:
Autonomous Univ Barcelona, Dept Urol, Fundacio Puigvert, Cartagena 340-350, Barcelona 08025, Spain
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