Patient characteristics and outcomes in metastatic upper tract urothelial carcinoma after radical nephroureterectomy: The experience of Japanese multi-institutions

Nobuyuki Tanaka, Eiji Kikuchi, Kent Kanao, Kazuhiro Matsumoto, Hiroaki Kobayashi, Yasumasa Miyazaki, Hiroki Ide, Jun Obata, Katsura Hoshino, Suguru Shirotake, Nozomi Hayakawa, Takeo Kosaka, Akira Miyajima, Tetsuo Momma, Ken Nakagawa, Shintaro Hasegawa, Yosuke Nakajima, Mototsugu Oya

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Abstract

Objectives To investigate oncological outcomes and prognostic factors in patients with upper tract urothelial carcinoma (UTUC) who experienced disease recurrence after radical nephroureterectomy (RNU). Few studies have focused on the clinical courses of patients who experienced disease recurrence after RNU. Patients and Methods A total of 204 UTUC patients who experienced disease recurrence from a retrospective multi-institutional cohort were included in the present study. Associated patient outcomes were analyzed using multivariate analysis. Results The mean time from RNU to first disease recurrence was 15.0 months and ≈90% of patients experienced disease recurrence within the first 3 years after RNU. During a median follow-up of 8.1 month after disease recurrence, 165 patients died from UTUC and five patients died from other causes. In the 204 cohorts, 1- and 3-year cancer-specific survival rates were 40.2% and 9.7%, respectively, and 1- and 3-year overall survival rates were 39.5% and 9.4%, respectively. After disease recurrence, 132 patients underwent systemic chemotherapy, and a subgroup analysis of patients who underwent systemic chemotherapy multivariate analysis showed that performance status, the presence of liver metastasis and the number of recurrence sites were independently prognostic of cancer-specific and overall survival after relapsing. According to three significant variables, 1- and 3-year cancer-specific survival rates were 72.7% and 20.8% in patients with no risk factors, 46.5% and 7.5% in patients with one risk factor, and 26.4% and 4.4% in patients with two or three risk factors, respectively (P < 0.001). Conclusions Most patients died from UTUC within 3 years, even though systemic chemotherapies were administered after relapsing. Multivariate analysis showed that performance status, the presence of liver metastasis and the number of recurrence sites were independently related to poor survival after systemic chemotherapy.

Original languageEnglish
Pages (from-to)E28-E34
JournalBJU international
Volume112
Issue number2
DOIs
Publication statusPublished - 2013 Jul

Keywords

  • metastasis
  • nephroureterectomy
  • outcome
  • upper urinary tract
  • urothelial carcinoma

ASJC Scopus subject areas

  • Urology

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    Tanaka, N., Kikuchi, E., Kanao, K., Matsumoto, K., Kobayashi, H., Miyazaki, Y., Ide, H., Obata, J., Hoshino, K., Shirotake, S., Hayakawa, N., Kosaka, T., Miyajima, A., Momma, T., Nakagawa, K., Hasegawa, S., Nakajima, Y., & Oya, M. (2013). Patient characteristics and outcomes in metastatic upper tract urothelial carcinoma after radical nephroureterectomy: The experience of Japanese multi-institutions. BJU international, 112(2), E28-E34. https://doi.org/10.1111/bju.12133