Impact of Tumor Location on Prognosis for Patients with Upper Tract Urothelial Carcinoma Managed by Radical Nephroureterectomy

Autor: Christopher G. Wood, Theresa M. Koppie, J. Stuart Wolf, Karim Bensalah, Shahrokh F. Shariat, Claudio Jeldres, Alon Z. Weizer, Vitaly Margulis, Marco Roscigno, Mario I. Fernández, Mesut Remzi, Richard Zigeuner, Pierre Karakiewcz, Philipp Ströbel, Wareef Kabbani, Mototsuga Oya, Christian Bolenz, Douglas S. Scherr, Jean Jacques Patard, Casey K. Ng, Mathias Waldert, Eiji Kikuchi, Jay D. Raman, Francesco Montorsi, Cord Langner, Hendrik Isbarn, Yair Lotan
Přispěvatelé: De Villemeur, Hervé, Cornell University [New York], Penn State Milton, S. Hershey Medical Center, MD Anderson Cancer Center, The University of Texas Health Science Center at Houston (UTHealth), University of Texas Southwestern Medical Center [Dallas], Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), Department of Urology, Keio University School of Medicine [Tokyo, Japan], Department of urology, Università Vita-Salute San Raffaele, Medical University Graz, University of Michigan [Ann Arbor], University of Michigan System, Mannheim Medical Center, Universität Heidelberg [Heidelberg], University of California [Davis] (UC Davis), University of California (UC), Université de Montréal (UdeM), Medizinische Universität Wien = Medical University of Vienna, Clinica Alemana de Santiago, Division of Urology, Sidney Kimmel Center for Prostate and Urologic Cancer, Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), University of California, Universität Heidelberg [Heidelberg] = Heidelberg University, Raman Jay, D., Ng Casey, K., Scherr Douglas, S., Margulis, Vitaly, Lotan, Yair, Bensalah, Karim, Patard Jean, Jacque, Kikuchi, Eiji, Montorsi, Francesco, Zigeuner, Richard, Weizer, Alon, Bolenz, Christian, Koppie Theresa, M., Isbarn, Hendrik, Jeldres, Claudio, Kabbani, Wareef, Remzi, Mesut, Waldert, Mathia, Wood Christopher, G., Roscigno, Marco, Oya, Mototsuga, Langner, Cord, Wolf J., Stuart, Stroebel, Philipp, Fernandez, Mario, Karakiewcz, Pierre, Shariat Shahrokh, F.
Jazyk: angličtina
Rok vydání: 2010
Předmět:
Zdroj: European Urology
European Urology, 2010, 57 (6), pp.1072-1079. ⟨10.1016/j.eururo.2009.07.002⟩
European Urology, Elsevier, 2010, 57 (6), pp.1072-1079. ⟨10.1016/j.eururo.2009.07.002⟩
ISSN: 0302-2838
1421-993X
DOI: 10.1016/j.eururo.2009.07.002⟩
Popis: Background: There is a lack of consensus regarding the prognostic significance of ureteral versus renal pelvic upper tract urothelial carcinoma (UTUC). Objective: To investigate the association of tumor location on outcomes for UTUC in an international cohort of patients managed by radical nephroureterectomy (RNU). Design, setting, and participants: A retrospective review of institutional databases from 10 institutions worldwide identified patients with UTUC. Intervention: The 1249 patients in the study underwent RNU with ipsilateral bladder cuff resection between 1987 and 2007. Measurements: Data accrued included age, gender, race, surgical approach (open vs laparoscopic), tumor pathology (stage, grade, lymph node status), tumor location, use of perioperative chemotherapy, prior endoscopic therapy, urothelial carcinoma recurrence, and mortality from urothelial carcinoma. Tumor location was divided into two groups (renal pelvis and ureter) based on the location of the dominant tumor. Results and limitations: The 5-yr recurrence-free and cancer-specific survival estimates for this cohort were 75% and 78%, respectively. On multivariate analysis, only pathologic tumor (pT) classification (p < 0.001), grade (p < 0.02), and lymph node status (p < 0.001) were associated with disease recurrence and cancer-specific survival. When adjusting for these variables, there was no difference in the probability of disease recurrence (hazard ratio [HR]: 1.22; p = 0.133) or cancer death (HR: 1.23; p = 0.25) between ureteral and renal pelvic tumors. Adding tumor location to a base prognostic model for disease recurrence and cancer death that included pT stage, tumor grade, and lymph node status only improved the predictive accuracy of this model by 0.1%. This study is limited by biases associated with its retrospective design. Conclusions: There is no difference in outcomes between patients with renal pelvic tumors and with ureteral tumors following nephroureterectomy. These data support the current TNM staging system, whereby renal pelvic and ureteral carcinomas are classified as one integral group of tumors. (c) European Association of Urology. Published by Elsevier B.V. All rights reserved.
Databáze: OpenAIRE
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