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

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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

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Carcinoma
Lymph Nodes
Neoplasms
Recurrence
Survival
Neoplasm Metastasis
Kidney Pelvis
Carcinoma in Situ
Lymph Node Excision
Urinary Bladder
Necrosis
Multivariate Analysis
Growth
Therapeutics

Keywords

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

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Margulis, V., Shariat, S. F., Matin, S. F., Kamat, A. M., Zigeuner, R., Kikuchi, E., ... 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

Outcomes of radical nephroureterectomy : A series from the upper tract urothelial carcinoma collaboration. / Margulis, Vitaly; Shariat, Shahrokh F.; Matin, Surena F.; Kamat, Ashish M.; Zigeuner, Richard; Kikuchi, Eiji; Lotan, Yair; Weizer, Alon; Raman, Jay D.; Wood, Christopher G.

In: Cancer, Vol. 115, No. 6, 15.03.2009, p. 1224-1233.

Research output: Contribution to journalArticle

Margulis, V, Shariat, SF, Matin, SF, Kamat, AM, Zigeuner, R, Kikuchi, E, Lotan, Y, Weizer, A, Raman, JD & Wood, CG 2009, 'Outcomes of radical nephroureterectomy: A series from the upper tract urothelial carcinoma collaboration', Cancer, vol. 115, no. 6, pp. 1224-1233. https://doi.org/10.1002/cncr.24135
Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E et al. Outcomes of radical nephroureterectomy: A series from the upper tract urothelial carcinoma collaboration. Cancer. 2009 Mar 15;115(6):1224-1233. https://doi.org/10.1002/cncr.24135
Margulis, Vitaly ; Shariat, Shahrokh F. ; Matin, Surena F. ; Kamat, Ashish M. ; Zigeuner, Richard ; Kikuchi, Eiji ; Lotan, Yair ; Weizer, Alon ; Raman, Jay D. ; Wood, Christopher G. / Outcomes of radical nephroureterectomy : A series from the upper tract urothelial carcinoma collaboration. In: Cancer. 2009 ; Vol. 115, No. 6. pp. 1224-1233.
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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.",
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T2 - A series from the upper tract urothelial carcinoma collaboration

AU - Margulis, Vitaly

AU - Shariat, Shahrokh F.

AU - Matin, Surena F.

AU - Kamat, Ashish M.

AU - Zigeuner, Richard

AU - Kikuchi, Eiji

AU - Lotan, Yair

AU - Weizer, Alon

AU - Raman, Jay D.

AU - Wood, Christopher G.

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N2 - 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.

AB - 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.

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KW - Transitional cell carcinoma

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