title: The Expanded Use of Percutaneous Resection for Upper Tract Urothelial Carcinoma: A 30-Year Comprehensive Experience.
abstract: BACKGROUND
  The gold standard treatment for upper tract urothelial carcinoma (UTUC) is radical nephroureterectomy (RNU). The role of endoscopic resection is limited to low-risk patients. In this study, we present our 30-year experience in the endoscopic management of UTUC.
  
  
  METHODS
  In this retrospective study, we identified 141 patients who underwent percutaneous UTUC resection. Demographic and clinical data were collected, including tumor characteristics, bacillus Calmette-Guérin (BCG) and mitomycin use, tumor recurrence, progression to RNU, and overall survival (OS), and compared in univariate and multivariate analyses.
  
  
  RESULTS
  Median follow-up was 66 months. Recurrence occurred in 37% of low-grade patients and 63% of high-grade (HG) patients, with a median time to recurrence of 71.4 vs 36.4 months, respectively. Grade was the only predictor of recurrence (HR 2.12, p = 0.018). The latest time to recurrence occurred after 116 months of surveillance. RNU was avoided by 87% of patients. Age, imperative indications for endoscopy, a history of bladder cancer, and tumor stage and grade were predictors of OS; however, in multivariate analysis, grade and stage lost significance. BCG and mitomycin did not protect against recurrence, progression to RNU, or death over resection alone.
  
  
  CONCLUSIONS
  Percutaneous management of UTUC allows for renal preservation in the majority of patients with resectable disease. Patients with HG tumors are more likely to experience recurrence, but are not at an increased risk of death. Intraluminal BCG and mitomycin continue to have a limited adjuvant role to resection. Recurrence may occur many years following initial resection and therefore prolonged surveillance is advised.
authors.affiliation: 1 Arthur Smith Institute for Urology, North Shore-Long Island Jewish Medical Center, New Hyde Park, New York.|2 Department of Urology, Yale University, New Haven, Connecticut.
authors.forename: Piruz
authors.initials: P
authors.lastname: Motamedinia
authors.affiliation: 1 Arthur Smith Institute for Urology, North Shore-Long Island Jewish Medical Center, New Hyde Park, New York.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Keheila
authors.affiliation: 1 Arthur Smith Institute for Urology, North Shore-Long Island Jewish Medical Center, New Hyde Park, New York.|3 Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan.
authors.forename: David A
authors.initials: DA
authors.lastname: Leavitt
authors.affiliation: 4 Icahn School of Medicine at Mt. Sinai, New York, New York.
authors.forename: Ardeshir R
authors.initials: AR
authors.lastname: Rastinehad
authors.affiliation: 1 Arthur Smith Institute for Urology, North Shore-Long Island Jewish Medical Center, New Hyde Park, New York.
authors.forename: Zeph
authors.initials: Z
authors.lastname: Okeke
authors.affiliation: 1 Arthur Smith Institute for Urology, North Shore-Long Island Jewish Medical Center, New Hyde Park, New York.
authors.forename: Arthur D
authors.initials: AD
authors.lastname: Smith
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D001500:BCG Vaccine / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000628:therapy*; D018450:Disease Progression; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000473:pathology / Q000601:surgery*
chemical_list: D000276:Adjuvants, Immunologic; D000903:Antibiotics, Antineoplastic; D001500:BCG Vaccine; D016685:Mitomycin