The impact of tumor multifocality on outcomes in patients treated with radical nephroureterectomy

Thomas F. Chromecki, Eugene K. Cha, Harun Fajkovic, Vitaly Margulis, Giacomo Novara, Douglas S. Scherr, Yair Lotan, Jay D. Raman, Wassim Kassouf, Karim Bensalah, Alon Weizer, Eiji Kikuchi, Marco Roscigno, Mesut Remzi, Kazumasa Matsumoto, Thomas J. Walton, Armin Pycha, Vincenzo Ficarra, Pierre I. Karakiewicz, Richard Zigeuner & 2 others Karl Pummer, Shahrokh F. Shariat

Research output: Contribution to journalArticle

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Abstract

Background: The prognostic impact of multifocal upper-tract urothelial carcinoma (UTUC) is poorly understood. Objective: To investigate the association between tumor multifocality and clinicopathologic features and outcomes of UTUC in patients managed by radical nephroureterectomy (RNU). Design, setting, and participants: The study included 2492 patients treated with either open or laparoscopic RNU. Tumor and patient characteristics included tumor stage, tumor grade, lymph node status, lymphovascular invasion (LVI), tumor architecture, tumor location, unifocal or multifocal disease, gender, age, history of bladder cancer (BCa), Eastern Cooperative Oncology Group (ECOG) performance status (PS), and adjuvant chemotherapy. tumor multifocality of UTUC was defined as the synchronous presence of multiple tumors in the renal pelvis or ureter. Intervention: All patients were treated with either open or laparoscopic RNU. Measurements: Univariable and multivariable models tested the effect of tumor multifocality on disease progression and cancer-specific mortality. Results and limitations: Five hundred ninety patients (23.7%) had tumor multifocality at the time of RNU. The median follow-up was 45 mo (interquartile range [IQR]: 0-101). Tumor multifocality was significantly associated with a history of previous BCa (p = 0.032), lymph node involvement (p = 0.036), tumor location in the ureter (p = 0.003), higher tumor stage (p < 0.001), higher tumor grade (p < 0.001), sessile tumor architecture (p = 0.003), and LVI (p = 0.001). In organ-confined patients, tumor multifocality was an independent predictor of both disease progression (hazard ratio [HR]: 1.43; p = 0.019) and cancer-specific mortality (HR: 1.46; p = 0.027). When assessed in all patients, tumor multifocality was associated with both disease progression and cancer-specific mortality in univariable (p = 0.005 and p = 0.006, respectively) but not in multivariable analyses (p = 0.468 and p = 0.798, respectively). The main limitation is the retrospective design of the study. Conclusions: Tumor multifocality is an independent prognosticator of disease progression and cancer-specific mortality in patients with organ-confined UTUC treated with RNU. Multifocal organ-confined patients with UTUC may need closer follow-up. Integration of tumor multifocality with other factors may help identify those patients who would benefit from multimodal therapy.

Original languageEnglish
Pages (from-to)245-253
Number of pages9
JournalEuropean Urology
Volume61
Issue number2
DOIs
Publication statusPublished - 2012 Feb

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Neoplasms
Disease Progression
Carcinoma
Mortality
Ureter
Urinary Bladder Neoplasms
Lymph Nodes
Kidney Pelvis
Adjuvant Chemotherapy
Retrospective Studies

Keywords

  • Cancer-specific survival
  • Multifocal
  • Radical nephroureterectomy
  • Survival
  • Urinary tract cancer
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Chromecki, T. F., Cha, E. K., Fajkovic, H., Margulis, V., Novara, G., Scherr, D. S., ... Shariat, S. F. (2012). The impact of tumor multifocality on outcomes in patients treated with radical nephroureterectomy. European Urology, 61(2), 245-253. https://doi.org/10.1016/j.eururo.2011.09.017

The impact of tumor multifocality on outcomes in patients treated with radical nephroureterectomy. / Chromecki, Thomas F.; Cha, Eugene K.; Fajkovic, Harun; Margulis, Vitaly; Novara, Giacomo; Scherr, Douglas S.; Lotan, Yair; Raman, Jay D.; Kassouf, Wassim; Bensalah, Karim; Weizer, Alon; Kikuchi, Eiji; Roscigno, Marco; Remzi, Mesut; Matsumoto, Kazumasa; Walton, Thomas J.; Pycha, Armin; Ficarra, Vincenzo; Karakiewicz, Pierre I.; Zigeuner, Richard; Pummer, Karl; Shariat, Shahrokh F.

In: European Urology, Vol. 61, No. 2, 02.2012, p. 245-253.

Research output: Contribution to journalArticle

Chromecki, TF, Cha, EK, Fajkovic, H, Margulis, V, Novara, G, Scherr, DS, Lotan, Y, Raman, JD, Kassouf, W, Bensalah, K, Weizer, A, Kikuchi, E, Roscigno, M, Remzi, M, Matsumoto, K, Walton, TJ, Pycha, A, Ficarra, V, Karakiewicz, PI, Zigeuner, R, Pummer, K & Shariat, SF 2012, 'The impact of tumor multifocality on outcomes in patients treated with radical nephroureterectomy', European Urology, vol. 61, no. 2, pp. 245-253. https://doi.org/10.1016/j.eururo.2011.09.017
Chromecki, Thomas F. ; Cha, Eugene K. ; Fajkovic, Harun ; Margulis, Vitaly ; Novara, Giacomo ; Scherr, Douglas S. ; Lotan, Yair ; Raman, Jay D. ; Kassouf, Wassim ; Bensalah, Karim ; Weizer, Alon ; Kikuchi, Eiji ; Roscigno, Marco ; Remzi, Mesut ; Matsumoto, Kazumasa ; Walton, Thomas J. ; Pycha, Armin ; Ficarra, Vincenzo ; Karakiewicz, Pierre I. ; Zigeuner, Richard ; Pummer, Karl ; Shariat, Shahrokh F. / The impact of tumor multifocality on outcomes in patients treated with radical nephroureterectomy. In: European Urology. 2012 ; Vol. 61, No. 2. pp. 245-253.
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abstract = "Background: The prognostic impact of multifocal upper-tract urothelial carcinoma (UTUC) is poorly understood. Objective: To investigate the association between tumor multifocality and clinicopathologic features and outcomes of UTUC in patients managed by radical nephroureterectomy (RNU). Design, setting, and participants: The study included 2492 patients treated with either open or laparoscopic RNU. Tumor and patient characteristics included tumor stage, tumor grade, lymph node status, lymphovascular invasion (LVI), tumor architecture, tumor location, unifocal or multifocal disease, gender, age, history of bladder cancer (BCa), Eastern Cooperative Oncology Group (ECOG) performance status (PS), and adjuvant chemotherapy. tumor multifocality of UTUC was defined as the synchronous presence of multiple tumors in the renal pelvis or ureter. Intervention: All patients were treated with either open or laparoscopic RNU. Measurements: Univariable and multivariable models tested the effect of tumor multifocality on disease progression and cancer-specific mortality. Results and limitations: Five hundred ninety patients (23.7{\%}) had tumor multifocality at the time of RNU. The median follow-up was 45 mo (interquartile range [IQR]: 0-101). Tumor multifocality was significantly associated with a history of previous BCa (p = 0.032), lymph node involvement (p = 0.036), tumor location in the ureter (p = 0.003), higher tumor stage (p < 0.001), higher tumor grade (p < 0.001), sessile tumor architecture (p = 0.003), and LVI (p = 0.001). In organ-confined patients, tumor multifocality was an independent predictor of both disease progression (hazard ratio [HR]: 1.43; p = 0.019) and cancer-specific mortality (HR: 1.46; p = 0.027). When assessed in all patients, tumor multifocality was associated with both disease progression and cancer-specific mortality in univariable (p = 0.005 and p = 0.006, respectively) but not in multivariable analyses (p = 0.468 and p = 0.798, respectively). The main limitation is the retrospective design of the study. Conclusions: Tumor multifocality is an independent prognosticator of disease progression and cancer-specific mortality in patients with organ-confined UTUC treated with RNU. Multifocal organ-confined patients with UTUC may need closer follow-up. Integration of tumor multifocality with other factors may help identify those patients who would benefit from multimodal therapy.",
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author = "Chromecki, {Thomas F.} and Cha, {Eugene K.} and Harun Fajkovic and Vitaly Margulis and Giacomo Novara and Scherr, {Douglas S.} and Yair Lotan and Raman, {Jay D.} and Wassim Kassouf and Karim Bensalah and Alon Weizer and Eiji Kikuchi and Marco Roscigno and Mesut Remzi and Kazumasa Matsumoto and Walton, {Thomas J.} and Armin Pycha and Vincenzo Ficarra and Karakiewicz, {Pierre I.} and Richard Zigeuner and Karl Pummer and Shariat, {Shahrokh F.}",
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TY - JOUR

T1 - The impact of tumor multifocality on outcomes in patients treated with radical nephroureterectomy

AU - Chromecki, Thomas F.

AU - Cha, Eugene K.

AU - Fajkovic, Harun

AU - Margulis, Vitaly

AU - Novara, Giacomo

AU - Scherr, Douglas S.

AU - Lotan, Yair

AU - Raman, Jay D.

AU - Kassouf, Wassim

AU - Bensalah, Karim

AU - Weizer, Alon

AU - Kikuchi, Eiji

AU - Roscigno, Marco

AU - Remzi, Mesut

AU - Matsumoto, Kazumasa

AU - Walton, Thomas J.

AU - Pycha, Armin

AU - Ficarra, Vincenzo

AU - Karakiewicz, Pierre I.

AU - Zigeuner, Richard

AU - Pummer, Karl

AU - Shariat, Shahrokh F.

PY - 2012/2

Y1 - 2012/2

N2 - Background: The prognostic impact of multifocal upper-tract urothelial carcinoma (UTUC) is poorly understood. Objective: To investigate the association between tumor multifocality and clinicopathologic features and outcomes of UTUC in patients managed by radical nephroureterectomy (RNU). Design, setting, and participants: The study included 2492 patients treated with either open or laparoscopic RNU. Tumor and patient characteristics included tumor stage, tumor grade, lymph node status, lymphovascular invasion (LVI), tumor architecture, tumor location, unifocal or multifocal disease, gender, age, history of bladder cancer (BCa), Eastern Cooperative Oncology Group (ECOG) performance status (PS), and adjuvant chemotherapy. tumor multifocality of UTUC was defined as the synchronous presence of multiple tumors in the renal pelvis or ureter. Intervention: All patients were treated with either open or laparoscopic RNU. Measurements: Univariable and multivariable models tested the effect of tumor multifocality on disease progression and cancer-specific mortality. Results and limitations: Five hundred ninety patients (23.7%) had tumor multifocality at the time of RNU. The median follow-up was 45 mo (interquartile range [IQR]: 0-101). Tumor multifocality was significantly associated with a history of previous BCa (p = 0.032), lymph node involvement (p = 0.036), tumor location in the ureter (p = 0.003), higher tumor stage (p < 0.001), higher tumor grade (p < 0.001), sessile tumor architecture (p = 0.003), and LVI (p = 0.001). In organ-confined patients, tumor multifocality was an independent predictor of both disease progression (hazard ratio [HR]: 1.43; p = 0.019) and cancer-specific mortality (HR: 1.46; p = 0.027). When assessed in all patients, tumor multifocality was associated with both disease progression and cancer-specific mortality in univariable (p = 0.005 and p = 0.006, respectively) but not in multivariable analyses (p = 0.468 and p = 0.798, respectively). The main limitation is the retrospective design of the study. Conclusions: Tumor multifocality is an independent prognosticator of disease progression and cancer-specific mortality in patients with organ-confined UTUC treated with RNU. Multifocal organ-confined patients with UTUC may need closer follow-up. Integration of tumor multifocality with other factors may help identify those patients who would benefit from multimodal therapy.

AB - Background: The prognostic impact of multifocal upper-tract urothelial carcinoma (UTUC) is poorly understood. Objective: To investigate the association between tumor multifocality and clinicopathologic features and outcomes of UTUC in patients managed by radical nephroureterectomy (RNU). Design, setting, and participants: The study included 2492 patients treated with either open or laparoscopic RNU. Tumor and patient characteristics included tumor stage, tumor grade, lymph node status, lymphovascular invasion (LVI), tumor architecture, tumor location, unifocal or multifocal disease, gender, age, history of bladder cancer (BCa), Eastern Cooperative Oncology Group (ECOG) performance status (PS), and adjuvant chemotherapy. tumor multifocality of UTUC was defined as the synchronous presence of multiple tumors in the renal pelvis or ureter. Intervention: All patients were treated with either open or laparoscopic RNU. Measurements: Univariable and multivariable models tested the effect of tumor multifocality on disease progression and cancer-specific mortality. Results and limitations: Five hundred ninety patients (23.7%) had tumor multifocality at the time of RNU. The median follow-up was 45 mo (interquartile range [IQR]: 0-101). Tumor multifocality was significantly associated with a history of previous BCa (p = 0.032), lymph node involvement (p = 0.036), tumor location in the ureter (p = 0.003), higher tumor stage (p < 0.001), higher tumor grade (p < 0.001), sessile tumor architecture (p = 0.003), and LVI (p = 0.001). In organ-confined patients, tumor multifocality was an independent predictor of both disease progression (hazard ratio [HR]: 1.43; p = 0.019) and cancer-specific mortality (HR: 1.46; p = 0.027). When assessed in all patients, tumor multifocality was associated with both disease progression and cancer-specific mortality in univariable (p = 0.005 and p = 0.006, respectively) but not in multivariable analyses (p = 0.468 and p = 0.798, respectively). The main limitation is the retrospective design of the study. Conclusions: Tumor multifocality is an independent prognosticator of disease progression and cancer-specific mortality in patients with organ-confined UTUC treated with RNU. Multifocal organ-confined patients with UTUC may need closer follow-up. Integration of tumor multifocality with other factors may help identify those patients who would benefit from multimodal therapy.

KW - Cancer-specific survival

KW - Multifocal

KW - Radical nephroureterectomy

KW - Survival

KW - Urinary tract cancer

KW - Urothelial carcinoma

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