Oncologic Outcomes of Endoscopic Management of Upper Tract Urothelial Carcinoma: A Systematic Review and Pooled Analysis from the EAU-YAU Urothelial Working Group

Background and objective: Data about the mid- and long-term oncologic outcomes of endoscopic kidney-sparing surgery (eKSS) for upper tract urothelial carcinoma (UTUC) are scarce. Therefore, we aimed to summarize the current evidence on the oncologic outcomes of eKSS for UTUC. Methods: A literature search was conducted to identify reports published until May 2024. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The outcomes were the following: recurrence-free (RFS), intravesical recurrence-free (IV-RFS), progression-free (PFS), cancer-specific (CSS), and overall (OS) survival. Key findings and limitations: We found 56 studies (n = 52 retrospective) that met our inclusion criteria (n = 2862 patients). The 1-, 2-, 5-, and 10-yr OS rates were 96%, 87%, 80%, and 42%, respectively. The 1-, 2-, 5-, and 10-yr CSS rates were 97%, 89%, 82%, and 69%, respectively. RFS rates at 1, 2, and 5 yr were 69%, 55%, and 45%, respectively. IV-RFS rates at 1, 2, and 5 yr were 80%, 65%, and 64%, respectively. PFS rates at 2 and 5 yr were 75% and 69%, respectively. In low-grade UTUC, OS rates at 2 and 5 yr were 93% and 77%, respectively. The 2- and 5-yr CSS rates were 98% and 88%, respectively. At 2 yr, RFS, IV-RFS, and PFS were 52%, 54%, and 94%, respectively. For high-grade UTUC, only three studies reported data on 2-yr RFS, which was 34%. The main limitation is the heterogeneity found across the studies. Conclusions and clinical implications: Local recurrence, bladder recurrence, and progression of UTUC occur mainly within 2 yr after eKSS. After 5-yr follow-up, OS and CSS drop, while the risk of local recurrence is non-negligible.