Upper tract urothelial carcinoma is rare but has a poor prognosis. Prognostic factors have been extensively studied in order to provide the best possible management for patients. We have aimed to investigate commonly available factors predictive of recurrence and survival in this patient population at high risk of death and recurrence, with an emphasis on the effects of age (using a cutoff of 70 years) on survival outcomes.
From 1387 patients with clinically nonmetastatic upper tract urothelial carcinoma treated with radical nephroureterectomy at 21 academic hospital centers between 2005 and 2021, 776 patients were eligible and included in the study. Univariable and multivariable Cox regression models were built to evaluate the independent prognosticators for intravesical and extravesical recurrence, overall survival, and cancer-specific survival according to age groups. A P value of <.05 was considered statistically significant.
We did not find an association between groups aged <70 and >70 years old and preoperatively clinical or histopathological characteristics. Kaplan-Meier analysis was found no statistical significance between the 2 age groups in terms of intravesical or extravesical recurrence (P = .09 and P = .57). Overall survival (P = .0001) and cancer-specific survival (P = .0001) have been found to be statistically significantly associated with age as independent predictors (confounding factors: gender, tumor size, tumor side, clinical T stage, localization, preoperative hydronephrosis, tumor localization, type of surgery, multifocality of the tumor, pathological grade, lymphovascular invasion, concomitant CIS, lymph node status, necrosis, or history of previous bladder cancer).
This research confirms that patients aged 70 and above who undergo radical nephroureterectomy may have worse outcomes compared to younger patients, older patients needing an improved care and management of UTUC to improve their outcomes in the setting of an increase in this aged population group.
Clinical genitourinary cancer. 2023 Aug 11 [Epub ahead of print]
Matteo Ferro, Sever Chiujdea, Mihai Dorin Vartolomei, Pierluigi Bove, Angelo Porreca, Gian Maria Busetto, Francesco Del Giudice, Alessandro Antonelli, Nazario Foschi, Marco Racioppi, Riccardo Autorino, Francesco Chiancone, Nicola Longo, Biagio Barone, Felice Crocetto, Gennaro Musi, Stefano Luzzago, Mattia Luca Piccinelli, Francesco Alessandro Mistretta, Ottavio de Cobelli, Octavian Sabin Tataru, Rodolfo Hurle, Giovanni Liguori, Marco Borghesi, Alessandro Veccia, Francesco Greco, Luigi Schips, Michele Marchioni, Giuseppe Lucarelli, Daniele Dutto, Fulvia Colucci, Giorgio Ivan Russo, Arturo Lo Giudice, Emanuele Montanari, Luca Boeri, Giuseppe Simone, Matteo Rosazza, Simone Livoti, Paolo Gontero, Francesco Soria
Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy. Electronic address: matteo.ferro@ieo.it., Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Urology, Medical University of Vienna, Wien, Austria; The Institution Organizing University Doctoral Studies (I.O.S.U.D.), George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, Târgu Mureș, Romania., San Carlo di Nancy Hospital, Rome, Italy; Department of Experimental Medicine, Tor vergata Oncoscience Research Centre of Excellence, TOR, University of Rome Tor Vergata, Rome, Italy., Oncological Urology, Veneto Institute of Oncology (IOV), IRCCS, Padua, Italy., Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy., Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy., Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy., Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy., Department of Urology, Rush University Medical Center, Chicago, IL., Department of Urology, A.O.R.N. A. Cardarelli, Naples, Italy., Urology Unit, Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy., Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy., Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy., The Institution Organizing University Doctoral Studies (I.O.S.U.D.), George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, Târgu Mureș, Romania; Department of Simulation Applied in Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, Târgu Mureș, Romania., Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy., Urology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy., Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Integrated Sciences (DISC), Urology Section, University of Genova, Genova, Italy., Department of Urology, IRCCS Humanitas Gavazzeni, Bergamo, Italy., Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio, University of Chieti, Chieti, Italy., Urology, Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy., Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy., Department of Surgery, Urology Section, University of Catania, Catania, Italy., Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy., Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy., Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.