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Comparative Study
. 2025 Apr 22;43(1):241.
doi: 10.1007/s00345-025-05626-0.

Endoscopic ablation versus nephroureterectomy in localized low-grade upper tract urothelial carcinoma: a comparison in terms of cancer-specific and other-cause mortality

Carolin Siech  1   2 , Letizia Maria Ippolita Jannello  3   4   5 , Mario de Angelis  3   6   7 , Francesco Di Bello  3   8 , Natali Rodriquez Peñaranda  3   9 , Jordan A Goyal  3 , Zhe Tian  3 , Fred Saad  3 , Shahrokh F Shariat  10   11   12   13 , Salvatore Micali  9 , Nicola Longo  8 , Ottavio de Cobelli  4   5   14 , Alberto Briganti  6   7 , Benedikt Hoeh  15 , Philipp Mandel  15 , Luis A Kluth  15 , Felix K H Chun  15 , Pierre I Karakiewicz  3
Affiliations
Comparative Study

Endoscopic ablation versus nephroureterectomy in localized low-grade upper tract urothelial carcinoma: a comparison in terms of cancer-specific and other-cause mortality

Carolin Siech et al. World J Urol. .

Abstract

Purpose: Guidelines recommend endoscopic ablation in select upper urinary tract urothelial carcinoma (UTUC) patients. To test for differences in cancer-specific mortality (CSM) and other-cause mortality (OCM) in localized non-invasive low-grade UTUC with tumor size < 2 cm treated with endoscopic ablation vs. radical nephroureterectomy.

Methods: Within Surveillance, Epidemiology, and End Results database (2000-2020), we identified UTUC patients treated with either endoscopic ablation or radical nephroureterectomy. After propensity score matching (ratio 1:1), cumulative incidence plots, and competing risks regression models addressed CSM and OCM.

Results: Of 249 included UTUC patients, 66 (27%) were treated with endoscopic ablation vs. 183 (73%) with radical nephroureterectomy. Over the study period, endoscopic ablation use increased from 10 to 45% (p = 0.01). After 1:1 propensity score matching, 66 of 66 (100%) endoscopic ablation and 66 of 183 (36%) radical nephroureterectomy patients were included. Ten-year CSM rates were 15.7% after endoscopic ablation vs. 13.9% after radical nephroureterectomy (p = 0.9). Ten-year OCM rates were 46.3% after endoscopic ablation vs. 57.9% after radical nephroureterectomy (p = 0.5). In multivariable competing risks regression models, CSM (hazard ratio 1.10; p = 0.9) and OCM (hazard ratio 0.83; p = 0.5) did not differ according to use of endoscopic ablation vs. radical nephroureterectomy.

Conclusion: Endoscopic ablation of localized non-invasive low-grade UTUC with tumor size < 2 cm results in absence of cancer-control outcome differences relative to radical nephroureterectomy. This observation validates the current guideline recommendations.

Keywords: Cancer-specific survival; Kidney-sparing management; Other-cause mortality; SEER; UTUC.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Estimated Percentage Increase (EPI) per three years of endoscopic ablation use in surgically-treated localized non-invasive low-grade upper urinary tract urothelial carcinoma (UTUC) patients with tumor size < 2 cm between 2000 and 2020. CI confidence interval
Fig. 2
Fig. 2
Cumulative incidence plot addressing cancer-specific mortality (CSM) and other-cause mortality (OCM) of localized non-invasive low-grade upper urinary tract urothelial carcinoma (UTUC) patients with tumor size < 2 cm according to treatment (endoscopic ablation vs. radical nephroureterectomy) after propensity score matching (ratio 1:1). CSM cancer-specific mortality, OCM other-cause mortality
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