AB065. Treatment strategies for upper tract urothelial carcinoma of the solitary functioning kidney: clinical analysis of 61 cases

Objective: To explore the treatment strategies for patients with upper tract urothelial carcinoma of the solitary functioning kidney.

Methods: Retrospective analysis of 61 cases who underwent operation for upper urinary tract urothelial carcinoma of the solitary functioning kidney from March 2000 to March 2012 was performed. Radical nephroureterectomy (RNU) or nephron-sparing surgery (NSS) was carried out. Patients were divided into three groups according to renal function: group A (Egfr ≥60 mL/min), group B (15mL/min ≤ eGFR <60 mL/min), group C (eGFR <15 mL/min). The main treatment for group A&B was NSS, and for Group C was RNU. We analyzed treatment results of patients with different renal function and surgical approach.

Results: Surgeries on all patients were successful. NSS group was associated with age (P=0.002), tumor size (P=0.013), without kidney transplantation (P=0.007) and better renal function (P=0.002). There were no significant differences in 5-year cancer-specific survival (CSS), overall survival (OS) and recurrence-free survival between the two groups. Only three patients needed to receive dialysis after operation. Postoperative follow-up, showed that bladder tumor recurrence rate was 60.0% in group A; three patients died of tumor and four patients had received kidney transplantation. In group B, urothelial tumor recurrence rate was 37.0%. Five patients died of tumor and one patient had received kidney transplantation. The rate of urothelial tumor recurrence in group C is 72.7%, and six patients died of tumor during the follow-up period. One patient had received kidney transplantation and the other patients needed dialysis in group C after operation. No differences were observed in 5 y-CSS, OS and recurrence-free survival rate in these three groups.

Conclusions: Renal function and clinicopathological characteristics are important in surgery selections of upper urinary tract urothelial tumor of the solitary functioning kidney. Nephron-sparing surgery can be considered as an alternative treatment.

Keywords: UTUC; solitary functioning kidney; nephron-sparing surgery (NSS); radical nephroureterectomy (RNU); renal function