Clinical Outcomes in Patients with Panurothelial Carcinoma Treated with Radical Nephroureterectomy Following Cystectomy for Metachronous Recurrence

Qiang Li, Melissa Assel, Nicole Benfante, Eugene Pietzak, Aditya Bagrodia, Eugene Cha, Guido Dalbagni, Jonathan Coleman

Research output: Contribution to journalArticle

Abstract

Purpose We report pathological, functional and oncologic outcomes in patients treated with radical nephroureterectomy following radical cystectomy. Materials and Methods We identified patients who underwent radical cystectomy and then radical nephroureterectomy for metachronous urothelial recurrence at our institution between January 1995 and December 2014. Univariable Cox regression was used to assess the association between overall survival and age, grade, stage, lymph node metastasis and radiographic findings. Results Of the 3,173 patients treated with radical cystectomy 64 underwent subsequent radical nephroureterectomy for metachronous urothelial recurrence. Median age at radical cystectomy was 66 years (IQR 61–74). In the 64 patients who underwent radical nephroureterectomy median time from radical cystectomy to radical nephroureterectomy was 2.7 years (IQR 1.4–4.6). Among 37 patients who underwent ureteroscopy prior to radical nephroureterectomy 29 (78%) had a positive biopsy. Radical nephroureterectomy pathology findings revealed locally advanced disease (pT3/pT4) in 39% of cases and positive node status in 11% compared with locally advanced disease in 17% and positive node status in 6% on radical cystectomy pathology findings. The post-radical nephroureterectomy estimated glomerular filtration rate was less than 60 and less than 30 ml/minute/1.73 m2 in 96% and 40% of patients, respectively. Median overall survival after radical nephroureterectomy was 3.1 years (95% CI 2.4–4.3). Only lymph node involvement at radical nephroureterectomy was significantly associated with worse overall mortality (HR 2.73, 95% CI 1.04–7.15, p = 0.041). Conclusions The prognosis is poor in patients with panurothelial carcinoma treated with nephroureterectomy following cystectomy with locally advanced disease in a large proportion. Renal function after these procedures diminished and almost all patients were ineligible for cisplatin based chemotherapy.

Original languageEnglish (US)
Pages (from-to)546-551
Number of pages6
JournalJournal of Urology
Volume198
Issue number3
DOIs
StatePublished - Sep 1 2017

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Cystectomy
Carcinoma
Recurrence
Lymph Nodes
Pathology
Ureteroscopy
Survival
Glomerular Filtration Rate
Cisplatin
Neoplasm Metastasis
Kidney
Biopsy
Drug Therapy
Mortality

Keywords

  • cystectomy
  • nephrectomy
  • treatment outcome
  • urinary bladder neoplasms
  • urothelium

ASJC Scopus subject areas

  • Urology

Cite this

Clinical Outcomes in Patients with Panurothelial Carcinoma Treated with Radical Nephroureterectomy Following Cystectomy for Metachronous Recurrence. / Li, Qiang; Assel, Melissa; Benfante, Nicole; Pietzak, Eugene; Bagrodia, Aditya; Cha, Eugene; Dalbagni, Guido; Coleman, Jonathan.

In: Journal of Urology, Vol. 198, No. 3, 01.09.2017, p. 546-551.

Research output: Contribution to journalArticle

Li, Qiang ; Assel, Melissa ; Benfante, Nicole ; Pietzak, Eugene ; Bagrodia, Aditya ; Cha, Eugene ; Dalbagni, Guido ; Coleman, Jonathan. / Clinical Outcomes in Patients with Panurothelial Carcinoma Treated with Radical Nephroureterectomy Following Cystectomy for Metachronous Recurrence. In: Journal of Urology. 2017 ; Vol. 198, No. 3. pp. 546-551.
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abstract = "Purpose We report pathological, functional and oncologic outcomes in patients treated with radical nephroureterectomy following radical cystectomy. Materials and Methods We identified patients who underwent radical cystectomy and then radical nephroureterectomy for metachronous urothelial recurrence at our institution between January 1995 and December 2014. Univariable Cox regression was used to assess the association between overall survival and age, grade, stage, lymph node metastasis and radiographic findings. Results Of the 3,173 patients treated with radical cystectomy 64 underwent subsequent radical nephroureterectomy for metachronous urothelial recurrence. Median age at radical cystectomy was 66 years (IQR 61–74). In the 64 patients who underwent radical nephroureterectomy median time from radical cystectomy to radical nephroureterectomy was 2.7 years (IQR 1.4–4.6). Among 37 patients who underwent ureteroscopy prior to radical nephroureterectomy 29 (78{\%}) had a positive biopsy. Radical nephroureterectomy pathology findings revealed locally advanced disease (pT3/pT4) in 39{\%} of cases and positive node status in 11{\%} compared with locally advanced disease in 17{\%} and positive node status in 6{\%} on radical cystectomy pathology findings. The post-radical nephroureterectomy estimated glomerular filtration rate was less than 60 and less than 30 ml/minute/1.73 m2 in 96{\%} and 40{\%} of patients, respectively. Median overall survival after radical nephroureterectomy was 3.1 years (95{\%} CI 2.4–4.3). Only lymph node involvement at radical nephroureterectomy was significantly associated with worse overall mortality (HR 2.73, 95{\%} CI 1.04–7.15, p = 0.041). Conclusions The prognosis is poor in patients with panurothelial carcinoma treated with nephroureterectomy following cystectomy with locally advanced disease in a large proportion. Renal function after these procedures diminished and almost all patients were ineligible for cisplatin based chemotherapy.",
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AU - Pietzak, Eugene

AU - Bagrodia, Aditya

AU - Cha, Eugene

AU - Dalbagni, Guido

AU - Coleman, Jonathan

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N2 - Purpose We report pathological, functional and oncologic outcomes in patients treated with radical nephroureterectomy following radical cystectomy. Materials and Methods We identified patients who underwent radical cystectomy and then radical nephroureterectomy for metachronous urothelial recurrence at our institution between January 1995 and December 2014. Univariable Cox regression was used to assess the association between overall survival and age, grade, stage, lymph node metastasis and radiographic findings. Results Of the 3,173 patients treated with radical cystectomy 64 underwent subsequent radical nephroureterectomy for metachronous urothelial recurrence. Median age at radical cystectomy was 66 years (IQR 61–74). In the 64 patients who underwent radical nephroureterectomy median time from radical cystectomy to radical nephroureterectomy was 2.7 years (IQR 1.4–4.6). Among 37 patients who underwent ureteroscopy prior to radical nephroureterectomy 29 (78%) had a positive biopsy. Radical nephroureterectomy pathology findings revealed locally advanced disease (pT3/pT4) in 39% of cases and positive node status in 11% compared with locally advanced disease in 17% and positive node status in 6% on radical cystectomy pathology findings. The post-radical nephroureterectomy estimated glomerular filtration rate was less than 60 and less than 30 ml/minute/1.73 m2 in 96% and 40% of patients, respectively. Median overall survival after radical nephroureterectomy was 3.1 years (95% CI 2.4–4.3). Only lymph node involvement at radical nephroureterectomy was significantly associated with worse overall mortality (HR 2.73, 95% CI 1.04–7.15, p = 0.041). Conclusions The prognosis is poor in patients with panurothelial carcinoma treated with nephroureterectomy following cystectomy with locally advanced disease in a large proportion. Renal function after these procedures diminished and almost all patients were ineligible for cisplatin based chemotherapy.

AB - Purpose We report pathological, functional and oncologic outcomes in patients treated with radical nephroureterectomy following radical cystectomy. Materials and Methods We identified patients who underwent radical cystectomy and then radical nephroureterectomy for metachronous urothelial recurrence at our institution between January 1995 and December 2014. Univariable Cox regression was used to assess the association between overall survival and age, grade, stage, lymph node metastasis and radiographic findings. Results Of the 3,173 patients treated with radical cystectomy 64 underwent subsequent radical nephroureterectomy for metachronous urothelial recurrence. Median age at radical cystectomy was 66 years (IQR 61–74). In the 64 patients who underwent radical nephroureterectomy median time from radical cystectomy to radical nephroureterectomy was 2.7 years (IQR 1.4–4.6). Among 37 patients who underwent ureteroscopy prior to radical nephroureterectomy 29 (78%) had a positive biopsy. Radical nephroureterectomy pathology findings revealed locally advanced disease (pT3/pT4) in 39% of cases and positive node status in 11% compared with locally advanced disease in 17% and positive node status in 6% on radical cystectomy pathology findings. The post-radical nephroureterectomy estimated glomerular filtration rate was less than 60 and less than 30 ml/minute/1.73 m2 in 96% and 40% of patients, respectively. Median overall survival after radical nephroureterectomy was 3.1 years (95% CI 2.4–4.3). Only lymph node involvement at radical nephroureterectomy was significantly associated with worse overall mortality (HR 2.73, 95% CI 1.04–7.15, p = 0.041). Conclusions The prognosis is poor in patients with panurothelial carcinoma treated with nephroureterectomy following cystectomy with locally advanced disease in a large proportion. Renal function after these procedures diminished and almost all patients were ineligible for cisplatin based chemotherapy.

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