Risk of cancer-specific mortality following recurrence after radical nephroureterectomy

Michael Rink, Daniel Sjoberg, Evi Comploj, Vitaly Margulis, Evanguelos Xylinas, Richard K. Lee, Jens Hansen, Eugene K. Cha, Jay D. Raman, Mesut Remzi, Karim Bensalah, Giacomo Novara, Surena F. Matin, Felix K. Chun, Eiji Kikuchi, Wassim Kassouf, Juan I. Martinez-Salamanca, Yair Lotan, Christian Seitz, Armin PychaRichard Zigeuner, Pierre I. Karakiewicz, Douglas S. Scherr, Andrew J. Vickers, Shahrokh F. Shariat

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Purpose. To describe the natural history and identify predictors of cancer-specific survival in patients who experience disease recurrence after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods. Of 2,494 UTUC patients treated with RNU without neoadjuvant chemotherapy, 597 patients experienced disease recurrence. A total of 148 patients (25 %) received adjuvant chemotherapy before disease recurrence. Multivariable Cox regression model addressed time to cancer-specific mortality after disease recurrence. Results. The median time from RNU to disease recurrence was 12 months (interquartile range 5-22). A total of 491 (82 %) of 597 patients died from UTUC, and 8 patients (1.3 %)died from other causes. The median time from disease recurrence to death of UTUC was 10 months. Actuarial cancer-specific survival estimate at 12 months after disease recurrence was 35 %. On multivariable analysis that adjusted for the effects of standard clinicopathologic characteristics, higher tumor stages [hazard ratio (HR) pT3 vs. pT0-T1: 1.66, p = 0.001; HR pT4 vs. pT0-T1: 1.90, p = 0.002], absence of lymph node dissection (HR 1.28, p = 0.041), ureteral tumor location (HR 1.44, p<0.0005) and a shorter interval from surgery to disease recurrence (p <0.0005) were significantly associated with cancer-specific mortality. The adjusted 6-, 12- and 24-month postrecurrence cancer-specific mortality was 73, 60 and 57 %, respectively. Conclusions. Approximately 80 % of patients who experience disease recurrence after RNU die within 2 years after recurrence. Patients with non-organ-confined stage, absence of lymph node dissection, ureteral tumor location and/or shorter time to disease recurrence died of their tumor more quickly than their counterparts. These factors should be considered in patient counseling and risk stratification for salvage treatment decision making.

Original languageEnglish
Pages (from-to)4337-4344
Number of pages8
JournalAnnals of Surgical Oncology
Volume19
Issue number13
DOIs
Publication statusPublished - 2012 Dec

Fingerprint

Recurrence
Mortality
Neoplasms
Carcinoma
Lymph Node Excision
Salvage Therapy
Survival
Adjuvant Chemotherapy
Natural History
Proportional Hazards Models
Counseling
Decision Making
Drug Therapy

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Rink, M., Sjoberg, D., Comploj, E., Margulis, V., Xylinas, E., Lee, R. K., ... Shariat, S. F. (2012). Risk of cancer-specific mortality following recurrence after radical nephroureterectomy. Annals of Surgical Oncology, 19(13), 4337-4344. https://doi.org/10.1245/s10434-012-2499-8

Risk of cancer-specific mortality following recurrence after radical nephroureterectomy. / Rink, Michael; Sjoberg, Daniel; Comploj, Evi; Margulis, Vitaly; Xylinas, Evanguelos; Lee, Richard K.; Hansen, Jens; Cha, Eugene K.; Raman, Jay D.; Remzi, Mesut; Bensalah, Karim; Novara, Giacomo; Matin, Surena F.; Chun, Felix K.; Kikuchi, Eiji; Kassouf, Wassim; Martinez-Salamanca, Juan I.; Lotan, Yair; Seitz, Christian; Pycha, Armin; Zigeuner, Richard; Karakiewicz, Pierre I.; Scherr, Douglas S.; Vickers, Andrew J.; Shariat, Shahrokh F.

In: Annals of Surgical Oncology, Vol. 19, No. 13, 12.2012, p. 4337-4344.

Research output: Contribution to journalArticle

Rink, M, Sjoberg, D, Comploj, E, Margulis, V, Xylinas, E, Lee, RK, Hansen, J, Cha, EK, Raman, JD, Remzi, M, Bensalah, K, Novara, G, Matin, SF, Chun, FK, Kikuchi, E, Kassouf, W, Martinez-Salamanca, JI, Lotan, Y, Seitz, C, Pycha, A, Zigeuner, R, Karakiewicz, PI, Scherr, DS, Vickers, AJ & Shariat, SF 2012, 'Risk of cancer-specific mortality following recurrence after radical nephroureterectomy', Annals of Surgical Oncology, vol. 19, no. 13, pp. 4337-4344. https://doi.org/10.1245/s10434-012-2499-8
Rink, Michael ; Sjoberg, Daniel ; Comploj, Evi ; Margulis, Vitaly ; Xylinas, Evanguelos ; Lee, Richard K. ; Hansen, Jens ; Cha, Eugene K. ; Raman, Jay D. ; Remzi, Mesut ; Bensalah, Karim ; Novara, Giacomo ; Matin, Surena F. ; Chun, Felix K. ; Kikuchi, Eiji ; Kassouf, Wassim ; Martinez-Salamanca, Juan I. ; Lotan, Yair ; Seitz, Christian ; Pycha, Armin ; Zigeuner, Richard ; Karakiewicz, Pierre I. ; Scherr, Douglas S. ; Vickers, Andrew J. ; Shariat, Shahrokh F. / Risk of cancer-specific mortality following recurrence after radical nephroureterectomy. In: Annals of Surgical Oncology. 2012 ; Vol. 19, No. 13. pp. 4337-4344.
@article{47d6910d42d543749dc41cbeb967929e,
title = "Risk of cancer-specific mortality following recurrence after radical nephroureterectomy",
abstract = "Purpose. To describe the natural history and identify predictors of cancer-specific survival in patients who experience disease recurrence after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods. Of 2,494 UTUC patients treated with RNU without neoadjuvant chemotherapy, 597 patients experienced disease recurrence. A total of 148 patients (25 {\%}) received adjuvant chemotherapy before disease recurrence. Multivariable Cox regression model addressed time to cancer-specific mortality after disease recurrence. Results. The median time from RNU to disease recurrence was 12 months (interquartile range 5-22). A total of 491 (82 {\%}) of 597 patients died from UTUC, and 8 patients (1.3 {\%})died from other causes. The median time from disease recurrence to death of UTUC was 10 months. Actuarial cancer-specific survival estimate at 12 months after disease recurrence was 35 {\%}. On multivariable analysis that adjusted for the effects of standard clinicopathologic characteristics, higher tumor stages [hazard ratio (HR) pT3 vs. pT0-T1: 1.66, p = 0.001; HR pT4 vs. pT0-T1: 1.90, p = 0.002], absence of lymph node dissection (HR 1.28, p = 0.041), ureteral tumor location (HR 1.44, p<0.0005) and a shorter interval from surgery to disease recurrence (p <0.0005) were significantly associated with cancer-specific mortality. The adjusted 6-, 12- and 24-month postrecurrence cancer-specific mortality was 73, 60 and 57 {\%}, respectively. Conclusions. Approximately 80 {\%} of patients who experience disease recurrence after RNU die within 2 years after recurrence. Patients with non-organ-confined stage, absence of lymph node dissection, ureteral tumor location and/or shorter time to disease recurrence died of their tumor more quickly than their counterparts. These factors should be considered in patient counseling and risk stratification for salvage treatment decision making.",
author = "Michael Rink and Daniel Sjoberg and Evi Comploj and Vitaly Margulis and Evanguelos Xylinas and Lee, {Richard K.} and Jens Hansen and Cha, {Eugene K.} and Raman, {Jay D.} and Mesut Remzi and Karim Bensalah and Giacomo Novara and Matin, {Surena F.} and Chun, {Felix K.} and Eiji Kikuchi and Wassim Kassouf and Martinez-Salamanca, {Juan I.} and Yair Lotan and Christian Seitz and Armin Pycha and Richard Zigeuner and Karakiewicz, {Pierre I.} and Scherr, {Douglas S.} and Vickers, {Andrew J.} and Shariat, {Shahrokh F.}",
year = "2012",
month = "12",
doi = "10.1245/s10434-012-2499-8",
language = "English",
volume = "19",
pages = "4337--4344",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",
number = "13",

}

TY - JOUR

T1 - Risk of cancer-specific mortality following recurrence after radical nephroureterectomy

AU - Rink, Michael

AU - Sjoberg, Daniel

AU - Comploj, Evi

AU - Margulis, Vitaly

AU - Xylinas, Evanguelos

AU - Lee, Richard K.

AU - Hansen, Jens

AU - Cha, Eugene K.

AU - Raman, Jay D.

AU - Remzi, Mesut

AU - Bensalah, Karim

AU - Novara, Giacomo

AU - Matin, Surena F.

AU - Chun, Felix K.

AU - Kikuchi, Eiji

AU - Kassouf, Wassim

AU - Martinez-Salamanca, Juan I.

AU - Lotan, Yair

AU - Seitz, Christian

AU - Pycha, Armin

AU - Zigeuner, Richard

AU - Karakiewicz, Pierre I.

AU - Scherr, Douglas S.

AU - Vickers, Andrew J.

AU - Shariat, Shahrokh F.

PY - 2012/12

Y1 - 2012/12

N2 - Purpose. To describe the natural history and identify predictors of cancer-specific survival in patients who experience disease recurrence after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods. Of 2,494 UTUC patients treated with RNU without neoadjuvant chemotherapy, 597 patients experienced disease recurrence. A total of 148 patients (25 %) received adjuvant chemotherapy before disease recurrence. Multivariable Cox regression model addressed time to cancer-specific mortality after disease recurrence. Results. The median time from RNU to disease recurrence was 12 months (interquartile range 5-22). A total of 491 (82 %) of 597 patients died from UTUC, and 8 patients (1.3 %)died from other causes. The median time from disease recurrence to death of UTUC was 10 months. Actuarial cancer-specific survival estimate at 12 months after disease recurrence was 35 %. On multivariable analysis that adjusted for the effects of standard clinicopathologic characteristics, higher tumor stages [hazard ratio (HR) pT3 vs. pT0-T1: 1.66, p = 0.001; HR pT4 vs. pT0-T1: 1.90, p = 0.002], absence of lymph node dissection (HR 1.28, p = 0.041), ureteral tumor location (HR 1.44, p<0.0005) and a shorter interval from surgery to disease recurrence (p <0.0005) were significantly associated with cancer-specific mortality. The adjusted 6-, 12- and 24-month postrecurrence cancer-specific mortality was 73, 60 and 57 %, respectively. Conclusions. Approximately 80 % of patients who experience disease recurrence after RNU die within 2 years after recurrence. Patients with non-organ-confined stage, absence of lymph node dissection, ureteral tumor location and/or shorter time to disease recurrence died of their tumor more quickly than their counterparts. These factors should be considered in patient counseling and risk stratification for salvage treatment decision making.

AB - Purpose. To describe the natural history and identify predictors of cancer-specific survival in patients who experience disease recurrence after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods. Of 2,494 UTUC patients treated with RNU without neoadjuvant chemotherapy, 597 patients experienced disease recurrence. A total of 148 patients (25 %) received adjuvant chemotherapy before disease recurrence. Multivariable Cox regression model addressed time to cancer-specific mortality after disease recurrence. Results. The median time from RNU to disease recurrence was 12 months (interquartile range 5-22). A total of 491 (82 %) of 597 patients died from UTUC, and 8 patients (1.3 %)died from other causes. The median time from disease recurrence to death of UTUC was 10 months. Actuarial cancer-specific survival estimate at 12 months after disease recurrence was 35 %. On multivariable analysis that adjusted for the effects of standard clinicopathologic characteristics, higher tumor stages [hazard ratio (HR) pT3 vs. pT0-T1: 1.66, p = 0.001; HR pT4 vs. pT0-T1: 1.90, p = 0.002], absence of lymph node dissection (HR 1.28, p = 0.041), ureteral tumor location (HR 1.44, p<0.0005) and a shorter interval from surgery to disease recurrence (p <0.0005) were significantly associated with cancer-specific mortality. The adjusted 6-, 12- and 24-month postrecurrence cancer-specific mortality was 73, 60 and 57 %, respectively. Conclusions. Approximately 80 % of patients who experience disease recurrence after RNU die within 2 years after recurrence. Patients with non-organ-confined stage, absence of lymph node dissection, ureteral tumor location and/or shorter time to disease recurrence died of their tumor more quickly than their counterparts. These factors should be considered in patient counseling and risk stratification for salvage treatment decision making.

UR - http://www.scopus.com/inward/record.url?scp=84876470645&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84876470645&partnerID=8YFLogxK

U2 - 10.1245/s10434-012-2499-8

DO - 10.1245/s10434-012-2499-8

M3 - Article

C2 - 22805867

AN - SCOPUS:84876470645

VL - 19

SP - 4337

EP - 4344

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 13

ER -