Outcomes of radical nephroureterectomy: A series from the upper tract urothelial carcinoma collaboration

Vitaly Margulis, Shahrokh F. Shariat, Surena F. Matin, Ashish M. Kamat, Richard Zigeuner, Eiji Kikuchi, Yair Lotan, Alon Weizer, Jay D. Raman, Christopher G. Wood

Research output: Contribution to journalArticle

614 Citations (Scopus)

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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 oncologie outcomes, which could potentially be used to select patients for adjuvant systemic therapy.

Original languageEnglish
Pages (from-to)1224-1233
Number of pages10
JournalCancer
Volume115
Issue number6
DOIs
Publication statusPublished - 2009 Mar 15

Keywords

  • Prognostic factors
  • Radical nephroureterectomy
  • Transitional cell carcinoma
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Fingerprint Dive into the research topics of 'Outcomes of radical nephroureterectomy: A series from the upper tract urothelial carcinoma collaboration'. Together they form a unique fingerprint.

  • Cite this

    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. (2009). Outcomes of radical nephroureterectomy: A series from the upper tract urothelial carcinoma collaboration. Cancer, 115(6), 1224-1233. https://doi.org/10.1002/cncr.24135