The impact of tumor size on outcomes in patients with upper urinary tract urothelial carcinoma

Purpose

To investigate the association between tumor size and clinicopathologic factors and outcomes of upper urinary tract urothelial carcinoma (UTUC) in patients treated surgically for UTUC.

Methods

A single-center series of 235 consecutive patients who were treated surgically for UTUC between January 1999 and December 2011 was evaluated. Patients with a history of muscle-invasive urothelial carcinoma of the urinary bladder, those who received neoadjuvant therapies, and those with previous contralateral UTUC were excluded. Bladder-only recurrence, any recurrence, and cancer-specific mortality after surgery were analyzed. Recurrence-free probabilities and cancer-specific survival (CSS) were estimated using the Kaplan–Meier method and Cox regression analyses.

Results

Tumor size was significantly associated with age of the patient (P = 0.001), tumor location (P < 0.0001), tumor multifocality (P = 0.005), higher tumor stage (P < 0.0001), higher tumor grade (P = 0.038), lymphovascular invasion (P = 0.002), and mode of operation (P = 0.001). Tumor size was not associated with bladder-only recurrence (HR 0.91; 95 % CI 0.46–1.80; P = 0.79). The Kaplan–Meier method showed that tumor size >3 cm was significantly associated with worse CSS (P = 0.006, log rank). The 5-year CSS for patients with tumor size ≤3 cm was 70.1 % and for patients with tumor size >3 cm was 56.1 %. Tumor size was not associated with cancer-specific survival in multivariable analysis (HR 1.53; 95 % CI 0.89–2.61; P = 0.12).

Conclusions

Tumor size >3 cm was associated with a lower 5-year CSS at Kaplan–Meier analysis, but was not an independent predictor of CSS, bladder-only recurrence, and any recurrence-free survival at multivariable analysis.