Mohammad Abufaraj, Beat Foerster, Tim Muilwijk, Gautier Marcq, Thomas Seisen, Roger Li, Leonardo L Monteiro, Marco Bandini, Donald Schweitzer, Alexander Kenigsberg, David D'Andrea, Kees Hendricksen, Francesco Soria, Giuseppe Fallara, Steven Joniau, Evanguelos Xylinas, Marco Moschini, Morgan Rouprêt, Alberto Briganti, Philippe E Spiess, Wassim Kassouf, Georgi Guruli, Hubert John, Dmitry Enikeev, Mounsif Azizi, Pierre Colin, Shahrokh F Shariat
Early recurrence at second-look URS appears to be one of the strongest predictive factors for RFS in patients undergoing endoscopic KSS. Our results suggest that second-look URS performed within 5 to 12 weeks is associated with a lower probability of further disease recurrence. Given that this interval was derived and tested in the same cohort, this finding should be regarded as hypothesis-generating and requires external validation before being adopted as a clinical standard.
OBJECTIVES: To investigate the rate and predictors of recurrence at second-look ureterorenoscopy (URS) and to assess the adequate timeframe for second-look URS in upper tract urothelial carcinoma (UTUC).
METHODS: This multicenter retrospective study included 179 patients who underwent endoscopic kidney-sparing surgery (KSS) and second-look URS for non-invasive UTUC between 2004 and 2017. We performed logistic and Cox proportional hazard regression analyses to investigate the association between clinical parameters and second-look recurrence, recurrence-free survival (RFS), and cancer-specific mortality. The optimal duration to second-look URS was extrapolated using restricted cubic splines.
RESULTS: Overall, 66 (36.9%) patients experienced recurrence at second-look URS. After second-look URS, further recurrence was observed in 87 (48.6%) patients during a median follow-up of 12 months. Female gender (OR [odds ratio] 2.3, 95% CI [confidence interval] 1.1-4.7, p = 0.026) and tumor size > 1 cm (OR 3.3, 95% CI 1.2-9.5, p = 0.027) were independently associated with recurrence at second look. Second-look recurrence was a strong prognostic factor for RFS (HR 5.0, 95% CI 3.1-8.0, p < 0.001). Second-look URS between 5 and 12 weeks after initial endoscopic laser ablation was an independent favorable factor for RFS (HR 0.5, 95% CI 0.3-0.9, p = 0.014).
CONCLUSIONS: Early recurrence at second-look URS appears to be one of the strongest predictive factors for RFS in patients undergoing endoscopic KSS. Our results suggest that second-look URS performed within 5 to 12 weeks is associated with a lower probability of further disease recurrence. Given that this interval was derived and tested in the same cohort, this finding should be regarded as hypothesis-generating and requires external validation before being adopted as a clinical standard.