TY - JOUR
T1 - Risk of cancer-specific mortality following recurrence after radical nephroureterectomy
AU - Rink, Michael
AU - Sjoberg, Daniel
AU - Comploj, Evi
AU - Margulis, Vitaly
AU - Xylinas, Evanguelos
AU - Lee, Richard K.
AU - Hansen, Jens
AU - Cha, Eugene K.
AU - Raman, Jay D.
AU - Remzi, Mesut
AU - Bensalah, Karim
AU - Novara, Giacomo
AU - Matin, Surena F.
AU - Chun, Felix K.
AU - Kikuchi, Eiji
AU - Kassouf, Wassim
AU - Martinez-Salamanca, Juan I.
AU - Lotan, Yair
AU - Seitz, Christian
AU - Pycha, Armin
AU - Zigeuner, Richard
AU - Karakiewicz, Pierre I.
AU - Scherr, Douglas S.
AU - Vickers, Andrew J.
AU - Shariat, Shahrokh F.
N1 - Funding Information:
ACKNOWLEDGMENT We thank the members of the Upper Tract Urothelial Carcinoma Collaboration (UTUCC): Thomas F. Chromecki, Eugene K. Cha, Mario Fernández, Vincenzo Ficarra, Wareef Kabbani, Eiji Kikuchi, Theresa M. Koppie, Kazumasa Mat-sumoto, Francesco Montorsi, Casey K. Ng, Mototsuga Oya, Jean-Jacques Patard, Armin Pycha, Marco Roscigno, Douglas S. Scherr, Philipp Ströbel, Stefan Tritschler, Thomas J. Walton, Alon Weizer, J. Stuart Wolf, and Christopher G. Wood. M.R. is supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. S.F.S. is an advisory board member of Ferring Pharma.
PY - 2012/12
Y1 - 2012/12
N2 - Purpose. To 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). Methods. Of 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. Results. The median time from RNU to disease recurrence was 12 months (interquartile range 5-22). 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-T1: 1.66, p = 0.001; HR pT4 vs. pT0-T1: 1.90, p = 0.002], absence of lymph node dissection (HR 1.28, p = 0.041), ureteral tumor location (HR 1.44, p<0.0005) and a shorter interval from surgery to disease recurrence (p <0.0005) were significantly associated with cancer-specific mortality. The adjusted 6-, 12- and 24-month postrecurrence cancer-specific mortality was 73, 60 and 57 %, respectively. 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.
AB - Purpose. To 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). Methods. Of 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. Results. The median time from RNU to disease recurrence was 12 months (interquartile range 5-22). 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-T1: 1.66, p = 0.001; HR pT4 vs. pT0-T1: 1.90, p = 0.002], absence of lymph node dissection (HR 1.28, p = 0.041), ureteral tumor location (HR 1.44, p<0.0005) and a shorter interval from surgery to disease recurrence (p <0.0005) were significantly associated with cancer-specific mortality. The adjusted 6-, 12- and 24-month postrecurrence cancer-specific mortality was 73, 60 and 57 %, respectively. 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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U2 - 10.1245/s10434-012-2499-8
DO - 10.1245/s10434-012-2499-8
M3 - Article
C2 - 22805867
AN - SCOPUS:84876470645
SN - 1068-9265
VL - 19
SP - 4337
EP - 4344
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 13
ER -