title: Immediate Nephroureterectomy or After Attempting Conservative Treatment, on Elective Indications, for Upper Urinary Tract Urothelial Carcinoma: Comparison of the Pathology Reports on a Retrospective Monocentric Study.
abstract: OBJECTIVE
  Conservative treatment (CT) with flexible ureteroscopy and laser ablation is an alternative to radical nephroureterectomy (RNU) for the treatment of the upper urinary tract urothelial carcinoma (UTUC). The purpose of this study was to compare the pathology results obtained after immediate RNU or after attempt of CT for elective indication.
  
  
  METHODS
  A retrospective study was conducted in a single tertiary center. All patients who had an RNU for urothelial carcinoma between 2007 and 2012 have been included. The patients were classified into two groups: group 1 is immediate RNU, and group 2 is RNU after CT (only elective indications). Preoperative data collected were as follows: age, sex, chronic kidney failure, radiological classification for cancer staging (TNM), tumor size, localization, and multifocal indication of CT. The pathological RNU data collected were tumor stage and grade. The T stage was divided into two groups (primary endpoint): pTa-T1-T2 and pT3-T4. The χ(2) test and Mann-Whitney was performed to compare the independent qualitative and quantitative variables, respectively.
  
  
  RESULTS
  A total of 51 patients were included (40 patients in the immediate RNU group and 11 patients in the delayed RNU group after CT). Patients in both groups had comparable characteristics regarding age, sex, location, T stage, and preoperative tumor grade. On final pathology, 23 tumors were classified as pTa-T1-T2 in the immediate RNU group compared with 6 in the delayed RNU group. Seventeen and five tumors were classified as T3 in group 1 and group 2, respectively. These results were not significantly different between both groups (p=0.866). The pathological RNU grade was not significantly different between the groups.
  
  
  CONCLUSIONS
  Within the limits of this retrospective study, the pathological RNU data showed no significant difference when RNU was done immediately or after CT for UTUC.
authors: Department of Urology, Tenon Hospital , Paris, France .
authors: Mattieu
authors: M
authors: Haddad
authors: Department of Urology, Tenon Hospital , Paris, France .
authors: Jonathan
authors: J
authors: Cloutier
authors: Department of Urology, Tenon Hospital , Paris, France .
authors: Jean Nicolas
authors: JN
authors: Cornu
authors: Department of Urology, Tenon Hospital , Paris, France .
authors: Luca
authors: L
authors: Villa
authors: Department of Urology, Tenon Hospital , Paris, France .
authors: Jean-Baptiste
authors: JB
authors: Terrasa
authors: Department of Urology, Tenon Hospital , Paris, France .
authors: Sabrina
authors: S
authors: Benbouzid
authors: Department of Urology, Tenon Hospital , Paris, France .
authors: Marie
authors: M
authors: Audouin
authors: Department of Urology, Tenon Hospital , Paris, France .
authors: Olivier
authors: O
authors: Cussenot
authors: Department of Urology, Tenon Hospital , Paris, France .
authors: Olivier
authors: O
authors: Traxer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D014513:Ureter / Q000601:surgery*; D014551:Urinary Tract / Q000601:surgery*; D014571:Urologic Neoplasms / Q000473:pathology / Q000601:surgery*