title: Survival Comparison Between Endoscopic and Surgical Management for Patients With Upper Tract Urothelial Cancer: A Matched Propensity Score Analysis Using Surveillance, Epidemiology and End Results-Medicare Data.
abstract: OBJECTIVE
  To determine survival differences among patients receiving endoscopic vs surgical management for upper tract urothelial carcinoma (UTUC).
  
  
  METHODS
  Using Surveillance, Epidemiology and End Results-Medicare data, patients diagnosed with nonmuscle-invasive, low-grade UTUC as their first cancer diagnosis between 2004 and 2009 were identified. Receipts of endoscopic and surgical interventions were assessed, and patients were separated into surgical or endoscopic management cohorts. Two-to-one propensity score analysis was performed to control for baseline characteristics between groups.
  
  
  RESULTS
  The endoscopic management (n = 151) and matched surgical management (n = 302) groups demonstrated no significant differences in age, gender, race, marital status, Charlson comorbidity index, or year of diagnosis. Endoscopic management was an independent and significant predictor of all-cause and cancer-specific mortality (hazard ratio 1.6 for overall survival [OS], hazard ratio 2.1 for cancer-specific survival [CSS]). Kaplan-Meier estimated survival was significantly lower for endoscopic management, with both OS and CSS curves diverging at approximately 24-36 months. A subset of patients initially receiving endoscopic management went on to receive surgical intervention (80/151 = 53%) at a median of 8.8 months from diagnosis. For these patients, Kaplan-Meier-estimated CSS was not significantly different from those who continued with only endoscopic management, and remained significantly lower than patients who received upfront surgery.
  
  
  CONCLUSIONS
  Although initial survival outcomes (first 24 months) are similar for endoscopic and surgical management of nonmuscle-invasive, low-grade UTUC, both CSS and OS are significantly inferior for the endoscopic management group in the longer term. Furthermore, transition from initial endoscopic management to surgical intervention appears to have limited impact on survival.
authors.affiliation: Department of Surgery, Division of Urology, Washington University in St. Louis, School of Medicine, St. Louis, MO.
authors.forename: Goutham
authors.initials: G
authors.lastname: Vemana
authors.affiliation: Department of Surgery, Division of Urology, Washington University in St. Louis, School of Medicine, St. Louis, MO.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Kim
authors.affiliation: Department of Surgery, Division of Urology, Washington University in St. Louis, School of Medicine, St. Louis, MO.
authors.forename: Sam B
authors.initials: SB
authors.lastname: Bhayani
authors.affiliation: Department of Surgery, Division of Urology, Washington University in St. Louis, School of Medicine, St. Louis, MO.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Vetter
authors.affiliation: Department of Surgery, Division of Urology, Washington University in St. Louis, School of Medicine, St. Louis, MO. Electronic address: stropes@wudosis.wustl.edu.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Strope
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D006278:Medicare; D057216:Propensity Score; D018426:SEER Program; D015996:Survival Rate; D014481:United States; D014516:Ureteral Neoplasms / Q000401:mortality* / Q000601:surgery*; D018666:Ureteroscopy; D013520:Urologic Surgical Procedures / Q000379:methods