The Conditional Survival with Time of Intravesical Recurrence of Upper Tract Urothelial Carcinoma

Keisuke Shigeta, Eiji Kikuchi, Masayuki Hagiwara, Toshiyuki Ando, Ryuichi Mizuno, Takayuki Abe, Shuji Mikami, Akira Miyajima, Ken Nakagawa, Mototsugu Oya

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Purpose: Since conditional survival analysis provides better estimates of survival time at each followup, we assessed changes in conditional intravesical recurrence-free survival rates after radical nephroureterectomy. We also sought to determine how the impact of well-known risk factors evolves with time, particularly in patients with localized upper tract urothelial carcinoma. Materials and Methods: We identified 364 patients with Ta-3N0M0 localized upper tract urothelial carcinoma who underwent open or laparoscopic radical nephroureterectomy at 1 of our 3 institutions. Conditional intravesical recurrence-free and cancer specific survival rates were calculated using the Kaplan-Meier method. The changing impact of parameters on intravesical recurrence with time was assessed by multivariate Cox regression analysis. Results: Intravesical recurrence after radical nephroureterectomy was detected in 176 patients (48.4%) and 93 (25.5%) died of localized upper tract urothelial carcinoma. Five-year intravesical recurrence-free and cancer specific survival rates after surgery were 41.5% and 72.9%, respectively. Based on 1, 2, 3 and 4-year survivorship the 5-year conditional intravesical recurrence-free survival rate increased from 41.5% to 60.5%, 73.4%, 79.5% and 96.7%, respectively. The 5-year conditional cancer specific survival rate also improved from 72.9% to 78.4%, 85.4%, 90.9% and 95.5% at 1, 2, 3 and 4 years, respectively. The effects of well-known predictive factors on estimated conditional survival decreased with time for intravesical recurrence. In contrast, the impact of T2 or lower pathological stage and laparoscopic radical nephroureterectomy sustained statistical power with time. Conclusions: Conditional survival analysis revealed that the probability of intravesical recurrence-free survival increased with time in patients with localized Ta-3N0M0 upper tract urothelial carcinoma after radical nephroureterectomy. Patients with T2 or lower T stage who undergo laparoscopic radical nephroureterectomy may be recommended for longer followup to detect subsequent intravesical recurrence.

Original languageEnglish
JournalJournal of Urology
DOIs
Publication statusAccepted/In press - 2017

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Carcinoma
Recurrence
Survival
Survival Rate
Survival Analysis
Neoplasms
Regression Analysis

Keywords

  • Carcinoma
  • Kidney
  • Local
  • Neoplasm recurrence
  • Survival analysis
  • Ureter

ASJC Scopus subject areas

  • Urology

Cite this

The Conditional Survival with Time of Intravesical Recurrence of Upper Tract Urothelial Carcinoma. / Shigeta, Keisuke; Kikuchi, Eiji; Hagiwara, Masayuki; Ando, Toshiyuki; Mizuno, Ryuichi; Abe, Takayuki; Mikami, Shuji; Miyajima, Akira; Nakagawa, Ken; Oya, Mototsugu.

In: Journal of Urology, 2017.

Research output: Contribution to journalArticle

Shigeta, Keisuke ; Kikuchi, Eiji ; Hagiwara, Masayuki ; Ando, Toshiyuki ; Mizuno, Ryuichi ; Abe, Takayuki ; Mikami, Shuji ; Miyajima, Akira ; Nakagawa, Ken ; Oya, Mototsugu. / The Conditional Survival with Time of Intravesical Recurrence of Upper Tract Urothelial Carcinoma. In: Journal of Urology. 2017.
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abstract = "Purpose: Since conditional survival analysis provides better estimates of survival time at each followup, we assessed changes in conditional intravesical recurrence-free survival rates after radical nephroureterectomy. We also sought to determine how the impact of well-known risk factors evolves with time, particularly in patients with localized upper tract urothelial carcinoma. Materials and Methods: We identified 364 patients with Ta-3N0M0 localized upper tract urothelial carcinoma who underwent open or laparoscopic radical nephroureterectomy at 1 of our 3 institutions. Conditional intravesical recurrence-free and cancer specific survival rates were calculated using the Kaplan-Meier method. The changing impact of parameters on intravesical recurrence with time was assessed by multivariate Cox regression analysis. Results: Intravesical recurrence after radical nephroureterectomy was detected in 176 patients (48.4{\%}) and 93 (25.5{\%}) died of localized upper tract urothelial carcinoma. Five-year intravesical recurrence-free and cancer specific survival rates after surgery were 41.5{\%} and 72.9{\%}, respectively. Based on 1, 2, 3 and 4-year survivorship the 5-year conditional intravesical recurrence-free survival rate increased from 41.5{\%} to 60.5{\%}, 73.4{\%}, 79.5{\%} and 96.7{\%}, respectively. The 5-year conditional cancer specific survival rate also improved from 72.9{\%} to 78.4{\%}, 85.4{\%}, 90.9{\%} and 95.5{\%} at 1, 2, 3 and 4 years, respectively. The effects of well-known predictive factors on estimated conditional survival decreased with time for intravesical recurrence. In contrast, the impact of T2 or lower pathological stage and laparoscopic radical nephroureterectomy sustained statistical power with time. Conclusions: Conditional survival analysis revealed that the probability of intravesical recurrence-free survival increased with time in patients with localized Ta-3N0M0 upper tract urothelial carcinoma after radical nephroureterectomy. Patients with T2 or lower T stage who undergo laparoscopic radical nephroureterectomy may be recommended for longer followup to detect subsequent intravesical recurrence.",
keywords = "Carcinoma, Kidney, Local, Neoplasm recurrence, Survival analysis, Ureter",
author = "Keisuke Shigeta and Eiji Kikuchi and Masayuki Hagiwara and Toshiyuki Ando and Ryuichi Mizuno and Takayuki Abe and Shuji Mikami and Akira Miyajima and Ken Nakagawa and Mototsugu Oya",
year = "2017",
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T1 - The Conditional Survival with Time of Intravesical Recurrence of Upper Tract Urothelial Carcinoma

AU - Shigeta, Keisuke

AU - Kikuchi, Eiji

AU - Hagiwara, Masayuki

AU - Ando, Toshiyuki

AU - Mizuno, Ryuichi

AU - Abe, Takayuki

AU - Mikami, Shuji

AU - Miyajima, Akira

AU - Nakagawa, Ken

AU - Oya, Mototsugu

PY - 2017

Y1 - 2017

N2 - Purpose: Since conditional survival analysis provides better estimates of survival time at each followup, we assessed changes in conditional intravesical recurrence-free survival rates after radical nephroureterectomy. We also sought to determine how the impact of well-known risk factors evolves with time, particularly in patients with localized upper tract urothelial carcinoma. Materials and Methods: We identified 364 patients with Ta-3N0M0 localized upper tract urothelial carcinoma who underwent open or laparoscopic radical nephroureterectomy at 1 of our 3 institutions. Conditional intravesical recurrence-free and cancer specific survival rates were calculated using the Kaplan-Meier method. The changing impact of parameters on intravesical recurrence with time was assessed by multivariate Cox regression analysis. Results: Intravesical recurrence after radical nephroureterectomy was detected in 176 patients (48.4%) and 93 (25.5%) died of localized upper tract urothelial carcinoma. Five-year intravesical recurrence-free and cancer specific survival rates after surgery were 41.5% and 72.9%, respectively. Based on 1, 2, 3 and 4-year survivorship the 5-year conditional intravesical recurrence-free survival rate increased from 41.5% to 60.5%, 73.4%, 79.5% and 96.7%, respectively. The 5-year conditional cancer specific survival rate also improved from 72.9% to 78.4%, 85.4%, 90.9% and 95.5% at 1, 2, 3 and 4 years, respectively. The effects of well-known predictive factors on estimated conditional survival decreased with time for intravesical recurrence. In contrast, the impact of T2 or lower pathological stage and laparoscopic radical nephroureterectomy sustained statistical power with time. Conclusions: Conditional survival analysis revealed that the probability of intravesical recurrence-free survival increased with time in patients with localized Ta-3N0M0 upper tract urothelial carcinoma after radical nephroureterectomy. Patients with T2 or lower T stage who undergo laparoscopic radical nephroureterectomy may be recommended for longer followup to detect subsequent intravesical recurrence.

AB - Purpose: Since conditional survival analysis provides better estimates of survival time at each followup, we assessed changes in conditional intravesical recurrence-free survival rates after radical nephroureterectomy. We also sought to determine how the impact of well-known risk factors evolves with time, particularly in patients with localized upper tract urothelial carcinoma. Materials and Methods: We identified 364 patients with Ta-3N0M0 localized upper tract urothelial carcinoma who underwent open or laparoscopic radical nephroureterectomy at 1 of our 3 institutions. Conditional intravesical recurrence-free and cancer specific survival rates were calculated using the Kaplan-Meier method. The changing impact of parameters on intravesical recurrence with time was assessed by multivariate Cox regression analysis. Results: Intravesical recurrence after radical nephroureterectomy was detected in 176 patients (48.4%) and 93 (25.5%) died of localized upper tract urothelial carcinoma. Five-year intravesical recurrence-free and cancer specific survival rates after surgery were 41.5% and 72.9%, respectively. Based on 1, 2, 3 and 4-year survivorship the 5-year conditional intravesical recurrence-free survival rate increased from 41.5% to 60.5%, 73.4%, 79.5% and 96.7%, respectively. The 5-year conditional cancer specific survival rate also improved from 72.9% to 78.4%, 85.4%, 90.9% and 95.5% at 1, 2, 3 and 4 years, respectively. The effects of well-known predictive factors on estimated conditional survival decreased with time for intravesical recurrence. In contrast, the impact of T2 or lower pathological stage and laparoscopic radical nephroureterectomy sustained statistical power with time. Conclusions: Conditional survival analysis revealed that the probability of intravesical recurrence-free survival increased with time in patients with localized Ta-3N0M0 upper tract urothelial carcinoma after radical nephroureterectomy. Patients with T2 or lower T stage who undergo laparoscopic radical nephroureterectomy may be recommended for longer followup to detect subsequent intravesical recurrence.

KW - Carcinoma

KW - Kidney

KW - Local

KW - Neoplasm recurrence

KW - Survival analysis

KW - Ureter

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