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Risk of Cancer-specific Mortality following Recurrence After Radical Nephroureterectomy |
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| Authors: | Michael Rink MD Daniel Sjoberg Evi Comploj MD Vitaly Margulis MD Evanguelos Xylinas MD Richard K. Lee MD Jens Hansen MD Eugene K. Cha MD Jay D. Raman MD Mesut Remzi MD Karim Bensalah MD Giacomo Novara MD Surena F. Matin MD Felix K. Chun MD Eiji Kikuchi MD Wassim Kassouf MD Juan I. Martinez-Salamanca MD Yair Lotan MD Christian Seitz MD Armin Pycha MD Richard Zigeuner MD Pierre I. Karakiewicz MD Douglas S. Scherr MD Andrew J. Vickers MD Shahrokh F. Shariat MD |
| Affiliation: | 1. Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA 2. University Medical Center Hamburg-Eppendorf, Hamburg, Germany 3. Memorial Sloan Kettering Cancer Center, New York, NY, USA 4. General Hospital of Bolzano, Bolzano, Italy 5. University of Texas Southwestern Medical Center, Dallas, TX, USA 6. Cochin Hospital, APHP, Paris Descartes University, Paris, France 7. University of Montr??al, Montreal, Quebec, Canada 8. Penn State Milton S. Hershey Medical Center, Hershey, PA, USA 9. Hospital Weinviertel-Korneuburg, Korneuburg, Austria 10. University of Rennes, Rennes, France 11. University of Padua, Padua, Italy 12. MD Anderson Cancer Center, Houston, TX, USA 13. Keio University School of Medicine, Tokyo, Japan 14. McGill University Health Center, Montreal, Quebec, Canada 15. University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain 16. St. John of God Hospital, Teaching Hospital of the Medical University, Vienna, Austria 17. Medical University of Graz, Graz, Austria |
| Abstract: | PurposeTo 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).MethodsOf 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.ResultsThe median time from RNU to disease recurrence was 12?months (interquartile range 5?C22). 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?CT1: 1.66, p?=?0.001; HR pT4 vs. pT0?CT1: 1.90, p?=?0.002], absence of lymph node dissection (HR 1.28, p?=?0.041), ureteral tumor location (HR 1.44, p?p?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. |
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