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European Urology

Volume 58, issue 4, pages e39-e50, October 2010

Urothelial Cancer

The Effect of Tumor Location on Prognosis in Patients Treated with Radical Nephroureterectomy at Memorial Sloan-Kettering Cancer Center eulogo1

Ricardo L. Favaretto, Shahrokh F. Shariat, Daher C. Chade, Guilherme Godoy, Ari Adamy, Matthew Kaag, Bernard H. Bochner, Jonathan Coleman and Guido Dalbagni

Accepted 1 July 2010, Published online 26 July 2010, pages 574 - 580

Abstract Full Text Full-Text PDF (171 KB) Create Platinum Slide Series

Fig. 1 Kaplan-Meier estimates of recurrence-free probabilities (any recurrence) following nephroureterectomy, stratified by tumor location.

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References in context

  • The 2- and 5-yr recurrence-free probabilities were 42% and 32%, respectively. Fig. 1 shows the probability of freedom from disease recurrence following RNU stratified by tumor location (p=0.18 by log-rank test).
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Fig. 2 Kaplan-Meier estimates of cancer-specific survival following nephroureterectomy, stratified by tumor location.

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References in context

  • The 5-yr CSS estimate was 78%. Fig. 2 shows the CSS estimates following RNU stratified by tumor location.
    Go to context

Table 1 Descriptive preoperative characteristics of 253 patients treated with radical nephroureterectomy and ipsilateral bladder cuff for upper-tract urothelial carcinoma

Variable All patients (n = 253) Tumor location*
Renal pelvis (n = 171) Ureter (n = 78) p value
Median age, yr (IQR) 72 (64–77) 71 (63–78) 73 (66–77) 0.7

Gender, No. (%)
 Male 159 (63) 104 (61) 52 (67) 0.4
 Female 94 (37) 67 (39) 26 (33) –

Race, No. (%)
 White 233 (92) 157 (92) 72 (92) 0.8
 Other 20 (8) 14 (8) 6 (8) –

ASA score, No. (%)
 1 7 (3) 4 (2) 3 (4) 0.8
 2 126 (50) 86 (51) 39 (50) –
 3 119 (47) 80 (47) 36 (46) –
Smoking history, No. (%) 186 (74) 128 (75) 54 (69) 0.4
Previous non-muscle–invasive bladder tumor, No. (%) 86 (34) 52 (30) 31 (40) 0.2
Previous endoscopic tumor ablation, No. (%) 20 (8) 10 (6) 6 (8) 0.6

Hematuria, No. (%)
 No 63 (25) 36 (21) 27 (35) 0.04
 Microhematuria 28 (11) 22 (13) 5 (6) –
 Gross hematuria 162 (64) 113 (66) 46 (59) –
Positive void cytology, No. (%) 191 (75) 126 (74) 64 (82) 0.3
Hydronephrosis on preoperative imaging, No. (%) 125 (49) 62 (36) 62 (79) <0.0001
Parenchymal/sinus fat extension or extraureter extension on imaging, No. (%) 26 (10) 30 (18) 6 (8) 0.05
Suspicious nodes on imaging, No. (%) 21 (8) 16 (9) 5 (6) 0.6
High-grade disease, No. (%)† 181 (73) 121 (71) 58 (74) 0.6

IQR = interquartile range; ASA = American Society of Anesthesiologists.

* n = 4, pT0 patients (submitted to previous endoscopic tumor ablation).

† Based on biopsy and wash/brush cytology.

References in context

  • Overall, 171 patients (69%) had a renal pelvic tumor, and 78 patients (31%) had a ureteral tumor (Table 1).
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Table 2 Pathology characteristics of 253 patients treated with radical nephroureterectomy and ipsilateral bladder cuff for upper tract urothelial carcinoma

Variable All patients (n = 253) Tumor location*
Renal pelvis (n = 171) Ureter (n = 78) p value
pT stage, No. (%)
 pT0 4 (1.6) – – –
 pTis 11 (4) 7 (4) 4 (5) 0.06
 pTa 70 (28) 54 (31.6) 16 (20.5) –
 pT1 47 (19) 31 (18) 16 (20.5) –
 pT2 56 (22) 31 (18) 25 (32) –
 pT3 59 (23) 42 (25) 17 (22) –
 pT4 6 (2.4) 6 (3.5) 0 (0) –

pN stage, No. (%)
 Nx 92 (36) 62 (36) 27 (35) 0.91
 N0 138 (55) 94 (55) 43 (55) –
 N+ 23 (9) 15 (9) 8 (10) –

Tumor grade, No. (%)
 Low 63 (25) 41 (24) 18 (23) 1.0
 High 190 (75) 130 (76) 60 (77) –

Tumor focality, No. (%)
 Unifocal 189 (75) 133 (78) 52 (67) 0.08
 Multifocal 64 (25) 38 (22) 26 (33) –

Concomitant CIS, No. (%)
 No 183 (72) 130 (76) 49 (63) 0.04
 Yes 70 (28) 41 (24) 29 (37) –

CIS = carcinoma in situ.

* n = 4, pT0 patients (submitted to previous endoscopic tumor ablation).

References in context

  • Although patients with ureteral tumor were more likely to have pT2 disease (32% vs 18%), those with renal pelvic tumor were more likely to have non–muscle-invasive UTUC (54% vs 46%; Table 2).
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Table 3 Univariate and multivariable Cox regression models predicting disease recurrence (any recurrence) in 253 patients treated with radical nephroureterectomy and ipsilateral bladder cuff for upper tract urothelial carcinoma

Univariate Multivariable
HR 95% CI p value HR 95% CI p value
Age 0.99 0.98–1.00 0.39 0.99 0.98–1.00 0.52

Gender
 Male Reference – – Reference – –
 Female 0.71 0.50–0.99 0.04 0.71 0.49–1.02 0.06
Previous bladder tumor 1.29 0.93–1.80 0.11 1.12 0.79–1.61 0.50

Tumor focality
 Unifocal Reference – – Reference – –
 Multifocal 1.34 0.94–1.91 0.10 1.16 0.79–1.71 0.43
Concomitant CIS 1.12 0.78–1.59 0.51 1.02 0.69–1.49 0.91
Postoperative chemotherapy 1.35 0.68–2.65 0.38 0.69 0.31–1.53 0.36

Tumor location
 Renal pelvis Reference – – Reference – –
 Ureter 1.25 0.89–1.75 0.19 1.19 0.83–1.70 0.32

Tumor grade
 Low Reference – – Reference – –
 High 1.18 0.81–1.72 0.36 0.96 0.62–1.48 0.85

pT classification
 pT0/pTis/pTa/pT1 Reference – – Reference – –
 pT2 1.37 0.92–2.06 0.11 1.29 0.84–1.98 0.23
 pT3/pT4 1.73 1.19–2.52 0.004 1.69 1.11–2.60 0.01

pN classification
 Nx Reference – – Reference – –
 N0 1.21 0.85–1.72 0.27 1.24 0.85–1.80 0.24
 N+ 2.20 1.28–3.77 0.004 1.79 0.92–3.51 0.08

HR = hazard ratio; CI = confidence interval; CIS = carcinoma in situ.

References in context

  • On univariate analyses, male gender, pathologic stage, and positive lymph nodes but not tumor location were associated with disease recurrence (Table 3).
    Go to context

Table 4 Univariate and multivariable Cox regression models predicting cancer-specific survival in 253 patients treated with radical nephroureterectomy and ipsilateral bladder cuff for upper tract urothelial carcinoma

Univariate Multivariable
HR 95% CI p value HR 95% CI p value
Age 1.03 1.00–1.06 0.02 – – –

Gender
 Male Reference – – – – –
 Female 0.84 0.46–1.53 0.57 – –
Previous bladder tumor 1.11 0.62–2.00 0.71 – – –

Tumor focality
 Unifocal Reference – – – – –
 Multifocal 0.92 0.47–1.80 0.81 – – –
Concomitant CIS 1.65 0.91–2.99 0.09 – – –
Postoperative chemotherapy 4.56 2.03–10.2 <0.0001 0.77 0.29–1.99 0.59

Tumor location
 Renal pelvis Reference – – Reference – –
 Ureter 1.38 0.77–2.48 0.27 1.30 0.72–2.37 0.33

Tumor grade
 Low Reference – – Reference – –
 High 3.09 1.31–7.29 0.01 1.92 0.76–4.80 0.16

pT classification
 pT0/pTis/pTa/pT1 Reference – – Reference – –
 pT2 4.17 1.61–10.7 0.003 3.43 1.31–8.98 0.01
 pT3/pT4 11.6 5.10–26.5 <0.0001 7.38 3.04–17.9 <0.0001

pN classification
 Nx Reference – – Reference – –
 N0 1.29 0.64–2.62 0.46 0.90 0.43–1.88 0.78
 N+ 10.4 4.80–22.5 <0.0001 2.95 1.24–7.03 0.01

HR = hazard ratio; CI = confidence interval; CIS = carcinoma in situ.

References in context

  • On univariate analyses, advanced age, postoperative chemotherapy, high tumor grade, pathologic stage, and metastasis to lymph nodes were associated with CSS (Table 4).
    Go to context

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