MATERIALS AND METHODS: We collected and pooled a database of 637 patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy and bladder cuff excision in nine international academic centres. Univariate and multivariate models examined the effect of tumour location on recurrence-free survival (RFS) and cancer-specific survival (CSS) rates. Collected variables included age, gender, race, presence of lymphovascular invasion, concomitant carcinoma in situ, pathological stage, lymph node dissection and type of surgery (open vs laparoscopic).
RESULTS: Anatomically, 34% of tumours were ureteral, 59% were renal pelvic and 7% were multifocal. Median follow-up for patients alive was 42 months (interquartile range: 19-76). Race, type of surgery, pathological stage and presence of lymphovascular invasion were significantly different across the three subgroups of patients (all P values < 0.05). Age, gender, grade, presence of concomitant carcinoma in situ and follow-up duration were similar among the three subgroups. On multivariable Cox regression analyses, ureteral tumour location was an independent predictor of worse RFS (hazard ratio 2.1, P= 0.006) and CSS (hazard ratio 2.0, P= 0.027). When associated with renal pelvic disease, ureteral location was an even stronger independent predictor of worse RFS (hazard ratio 4.6, P < 0.001) and CSS (hazard ratio 4.0, P < 0.001).
CONCLUSION: Ureteral tumour location, particularly in association with multifocal disease in the renal pelvis, is an independent prognostic factor for higher disease recurrence and cancer-specific mortality.
Written by:
Yafi FA, Novara G, Shariat SF, Gupta A, Matsumoto K, Walton TJ, Fritsche HM, El-Hakim A, Trischler S, Martínez-Salamanca JI, Seitz C, Ficarra V, Zattoni F, Karakiewicz PI, Kassouf W. Are you the author?
McGill University Health Center, Montreal, Quebec, Canada; University of Padua, Padua, Italy; Weill Medical College of Cornell, NY, USA; Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan; Derby City General Hospital, Derby, UK; Caritas St Josef Medical Centre, University of Regensburg, Regensburg, Germany; Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany; Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain; General Hospital Bolzano, Bolzano, Italy; University of Montreal, Montreal, Quebec, Canada.
Reference: BJU Int. 2011 Dec 16. Epub ahead of print.
doi: 10.1111/j.1464-410X.2011.10792.x
PubMed Abstract
PMID: 22177329
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