Vitaly Margulis and Shahrokh F. Shariat contributed equally to this manuscript.
Outcomes of radical nephroureterectomy: A series from the Upper Tract Urothelial Carcinoma Collaboration
Version of Record online: 20 JAN 2009
Copyright © 2009 American Cancer Society
Volume 115, Issue 6, pages 1224–1233, 15 March 2009
How to Cite
Margulis, V., Shariat, S. F., Matin, S. F., Kamat, A. M., Zigeuner, R., Kikuchi, E., Lotan, Y., Weizer, A., Raman, J. D., Wood, C. G. and the Upper Tract Urothelial Carcinoma Collaboration (2009), Outcomes of radical nephroureterectomy: A series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer, 115: 1224–1233. doi: 10.1002/cncr.24135
- Issue online: 3 MAR 2009
- Version of Record online: 20 JAN 2009
- Manuscript Accepted: 18 SEP 2008
- Manuscript Revised: 23 AUG 2008
- Manuscript Received: 7 JUL 2008
- transitional cell carcinoma;
- urothelial carcinoma;
- radical nephroureterectomy;
- prognostic factors
The literature on upper tract urothelial carcinoma (UTUC) has been limited to small, single center studies. A large series of patients treated with radical nephroureterectomy for UTUC were studied, and variables associated with poor prognosis were identified.
Data on 1363 patients treated with radical nephroureterectomy at 12 academic centers were collected. All pathologic slides were re-reviewed by genitourinary pathologists according to strict criteria.
Pathologic review revealed renal pelvis location (64%), necrosis (21.6%), lymphovascular invasion (LVI) (24.8%), concomitant carcinoma in situ (28.7%), and high-grade disease (63.7%). A total of 590 patients (43.3%) underwent concurrent, lymphadenectomy and 135 (9.9%) were lymph node (LN) -positive. Over a mean follow-up of 51 months, 379 (28%) patients experienced disease recurrence outside of the bladder and 313 (23%) died of UTUC. The 5-year recurrence-free and cancer-specific survival probabilities (±SD) were 69% ± 1% and 73% ± 1%, respectively. On multivariate analysis, high tumor grade (hazards ratio [HR]: 2.0, P < .001), advancing pathologic T stage (P-for-trend <.001), LN metastases (HR: 1.8, P < .001), infiltrative growth pattern (HR: 1.5, P < .001), and LVI (HR: 1.2, P = .041) were associated with disease recurrence. Similarly, patient age (HR: 1.1, P = .001), high tumor grade (HR: 1.7, P = .001), increasing pathologic T stage (P-for-trend <.001), LN metastases (HR: 1.7, P < .001), sessile architecture (HR: 1.5, P = .002), and LVI (HR: 1.4, P = .02) were independently associated with cancer-specific survival.
Radical nephroureterectomy provided durable local control and cancer-specific survival in patients with localized UTUC. Pathologic tumor grade, T stage, LN status, tumor architecture, and LVI were important prognostic variables associated with oncologic outcomes, which could potentially be used to select patients for adjuvant systemic therapy. Cancer 2009. © 2009 American Cancer Society.