A delay in radical nephroureterectomy can lead to upstaging

Matthias Waldert, Pierre I. Karakiewicz, Jay D. Raman, Mesut Remzi, Hendrik Isbarn, Yair Lotan, Umberto Capitanio, Karim Bensalah, Michael J. Marberger, Shahrokh F. Shariat

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Abstract

Study Type - Prognosis (case series) Level of Evidence 4 Objective: To examine the association between the delay from diagnosis of upper-tract urothelial carcinoma (UTUC) to radical nephroureterectomy (RNU), and the pathological features and outcomes, as the decision to proceed to RNU for an individual patient is complex. Patients and methods: The records of 187 patients who had RNU were reviewed; the interval from diagnosis to RNU was analysed as both a continuous (months) and categorical variable (<3 vs ≥3 months). Logistic regression and survival analyses were used to evaluate the association between time from diagnosis to RNU with pathological characteristics and clinical outcomes. Results: The median time from diagnosis to RNU was 45 days (interquartile range 68). A delay from diagnosis to RNU analysed as a continuous variable was associated with advanced stage, higher grade, previous endoscopic procedure, tumour necrosis, infiltrative tumour architecture, and lymphovascular invasion (P = 0.034), but not disease recurrence or cancer-specific mortality. In the subgroup of patients (90, 48.1%) who had muscle-invasive disease (≥pT2) a longer delay from diagnosis to RNU as a continuous variable was associated with advanced stage (P = 0.030), higher grade (P = 0.014), infiltrative tumour architecture (P = 0.044), lymphovascular invasion (P = 0.034), disease recurrence (P = 0.02), and cancer-specific mortality (P = 0.03). Conclusion:S Our data suggest that a delay in the interval from diagnosis to RNU is associated with more advanced disease stage. These findings might have important implications for trial design in the ongoing evaluation of neoadjuvant regimens. Timely consideration of definitive treatment for patients with high-risk UTUC is of high importance. Further studies are necessary to validate these hypothesis-generating findings.

Original languageEnglish (US)
Pages (from-to)812-817
Number of pages6
JournalBJU International
Volume105
Issue number6
DOIs
StatePublished - Mar 2010

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Neoplasms
Carcinoma
Recurrence
Mortality
Survival Analysis
Necrosis
Logistic Models
Regression Analysis
Muscles
Therapeutics

Keywords

  • Delay
  • Nephroureterectomy
  • Prognosis
  • Recurrence
  • Survival
  • Urinary tract cancer
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Waldert, M., Karakiewicz, P. I., Raman, J. D., Remzi, M., Isbarn, H., Lotan, Y., ... Shariat, S. F. (2010). A delay in radical nephroureterectomy can lead to upstaging. BJU International, 105(6), 812-817. https://doi.org/10.1111/j.1464-410X.2009.08821.x

A delay in radical nephroureterectomy can lead to upstaging. / Waldert, Matthias; Karakiewicz, Pierre I.; Raman, Jay D.; Remzi, Mesut; Isbarn, Hendrik; Lotan, Yair; Capitanio, Umberto; Bensalah, Karim; Marberger, Michael J.; Shariat, Shahrokh F.

In: BJU International, Vol. 105, No. 6, 03.2010, p. 812-817.

Research output: Contribution to journalArticle

Waldert, M, Karakiewicz, PI, Raman, JD, Remzi, M, Isbarn, H, Lotan, Y, Capitanio, U, Bensalah, K, Marberger, MJ & Shariat, SF 2010, 'A delay in radical nephroureterectomy can lead to upstaging', BJU International, vol. 105, no. 6, pp. 812-817. https://doi.org/10.1111/j.1464-410X.2009.08821.x
Waldert M, Karakiewicz PI, Raman JD, Remzi M, Isbarn H, Lotan Y et al. A delay in radical nephroureterectomy can lead to upstaging. BJU International. 2010 Mar;105(6):812-817. https://doi.org/10.1111/j.1464-410X.2009.08821.x
Waldert, Matthias ; Karakiewicz, Pierre I. ; Raman, Jay D. ; Remzi, Mesut ; Isbarn, Hendrik ; Lotan, Yair ; Capitanio, Umberto ; Bensalah, Karim ; Marberger, Michael J. ; Shariat, Shahrokh F. / A delay in radical nephroureterectomy can lead to upstaging. In: BJU International. 2010 ; Vol. 105, No. 6. pp. 812-817.
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abstract = "Study Type - Prognosis (case series) Level of Evidence 4 Objective: To examine the association between the delay from diagnosis of upper-tract urothelial carcinoma (UTUC) to radical nephroureterectomy (RNU), and the pathological features and outcomes, as the decision to proceed to RNU for an individual patient is complex. Patients and methods: The records of 187 patients who had RNU were reviewed; the interval from diagnosis to RNU was analysed as both a continuous (months) and categorical variable (<3 vs ≥3 months). Logistic regression and survival analyses were used to evaluate the association between time from diagnosis to RNU with pathological characteristics and clinical outcomes. Results: The median time from diagnosis to RNU was 45 days (interquartile range 68). A delay from diagnosis to RNU analysed as a continuous variable was associated with advanced stage, higher grade, previous endoscopic procedure, tumour necrosis, infiltrative tumour architecture, and lymphovascular invasion (P = 0.034), but not disease recurrence or cancer-specific mortality. In the subgroup of patients (90, 48.1{\%}) who had muscle-invasive disease (≥pT2) a longer delay from diagnosis to RNU as a continuous variable was associated with advanced stage (P = 0.030), higher grade (P = 0.014), infiltrative tumour architecture (P = 0.044), lymphovascular invasion (P = 0.034), disease recurrence (P = 0.02), and cancer-specific mortality (P = 0.03). Conclusion:S Our data suggest that a delay in the interval from diagnosis to RNU is associated with more advanced disease stage. These findings might have important implications for trial design in the ongoing evaluation of neoadjuvant regimens. Timely consideration of definitive treatment for patients with high-risk UTUC is of high importance. Further studies are necessary to validate these hypothesis-generating findings.",
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