Conditional survival after radical nephroureterectomy for upper tract carcinoma

Guillaume Ploussard, Evanguelos Xylinas, Yair Lotan, Giacomo Novara, Vitaly Margulis, Morgan Rouprêt, Kazumasa Matsumoto, Pierre I. Karakiewicz, Francesco Montorsi, Mezut Remzi, Christian Seitz, Douglas S. Scherr, Anil Kapoor, Adrian S. Fairey, Ricardo Rendon, Jonathan Izawa, Peter C. Black, Louis Lacombe, Shahrokh F. Shariat, Wassim Kassouf

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background Conditional survival (CS) provides better estimates of the survival probability at each follow-up time, and its usefulness has been proven in several solid malignancies. Objective To assess the changes in 5-yr CS rates after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) and to determine how well-established prognostic factors evolve over time. Design, setting, and participants We analysed data from 3544 patients treated with RNU at 15 international academic centres between 1989 and 2012. Intervention RNU. Outcomes measurements and statistical analysis Conditional intravesical recurrence-free (IVRFS), cancer-specific survival (CSS), and overall survival (OS) estimates were calculated using the Kaplan-Meier method. A multivariable Cox regression model was used to calculate proportional hazard ratios for the prediction of mortality. Results and limitations The 5-yr bladder cancer recurrence-free survival, CSS, and OS rates were 54.9%, 72.2%, and 62.6%, respectively. Given a 1-, 2-, 3-, and 4-yr survivorship, the 5-yr conditional OS rates improved to 65.2%, 69.3%, 71.5%, and 73.0%, respectively. The 5-yr CS improvement was primarily noted among surviving patients with advanced-stage disease. The impact of pathologic parameters on CS estimates decreased over time for both CSS and OS, whereas the impact of age and gender increased with survivorship. No survival benefit was noted regarding the adjuvant chemotherapy status. Findings were confirmed upon multivariable analyses. Tumour location, the presence of carcinoma in situ, and the type of bladder cuff excision were continuously predictive for IVRFS whatever the survivorship. A limitation is the retrospective design. Conclusions CS analysis demonstrates that the patient risk profile evolves during the post-RNU follow-up. The probability of survival markedly increases over time in patients having high-stage disease. The impact of prognostic pathologic features decreases over time and can disappear for long-term CS. Patient summary In this study, we found that the risk of intravesical recurrence, cancer-specific survival, and overall mortality evolves over the follow-up after surgery. Taking into account the survivorship provides better estimates of the survival probability at each follow-up time.

Original languageEnglish (US)
Pages (from-to)803-812
Number of pages10
JournalEuropean Urology
Volume67
Issue number4
DOIs
StatePublished - Apr 1 2015

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Carcinoma
Survival
Survival Rate
Neoplasms
Recurrence
Mortality
Carcinoma in Situ
Adjuvant Chemotherapy
Survival Analysis
Proportional Hazards Models
Urinary Bladder Neoplasms
Urinary Bladder

Keywords

  • Bladder cancer
  • Outcomes
  • Radical nephroureterectomy
  • Recurrence
  • Survival
  • Upper urinary tract carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Conditional survival after radical nephroureterectomy for upper tract carcinoma. / Ploussard, Guillaume; Xylinas, Evanguelos; Lotan, Yair; Novara, Giacomo; Margulis, Vitaly; Rouprêt, Morgan; Matsumoto, Kazumasa; Karakiewicz, Pierre I.; Montorsi, Francesco; Remzi, Mezut; Seitz, Christian; Scherr, Douglas S.; Kapoor, Anil; Fairey, Adrian S.; Rendon, Ricardo; Izawa, Jonathan; Black, Peter C.; Lacombe, Louis; Shariat, Shahrokh F.; Kassouf, Wassim.

In: European Urology, Vol. 67, No. 4, 01.04.2015, p. 803-812.

Research output: Contribution to journalArticle

Ploussard, G, Xylinas, E, Lotan, Y, Novara, G, Margulis, V, Rouprêt, M, Matsumoto, K, Karakiewicz, PI, Montorsi, F, Remzi, M, Seitz, C, Scherr, DS, Kapoor, A, Fairey, AS, Rendon, R, Izawa, J, Black, PC, Lacombe, L, Shariat, SF & Kassouf, W 2015, 'Conditional survival after radical nephroureterectomy for upper tract carcinoma', European Urology, vol. 67, no. 4, pp. 803-812. https://doi.org/10.1016/j.eururo.2014.08.003
Ploussard, Guillaume ; Xylinas, Evanguelos ; Lotan, Yair ; Novara, Giacomo ; Margulis, Vitaly ; Rouprêt, Morgan ; Matsumoto, Kazumasa ; Karakiewicz, Pierre I. ; Montorsi, Francesco ; Remzi, Mezut ; Seitz, Christian ; Scherr, Douglas S. ; Kapoor, Anil ; Fairey, Adrian S. ; Rendon, Ricardo ; Izawa, Jonathan ; Black, Peter C. ; Lacombe, Louis ; Shariat, Shahrokh F. ; Kassouf, Wassim. / Conditional survival after radical nephroureterectomy for upper tract carcinoma. In: European Urology. 2015 ; Vol. 67, No. 4. pp. 803-812.
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abstract = "Background Conditional survival (CS) provides better estimates of the survival probability at each follow-up time, and its usefulness has been proven in several solid malignancies. Objective To assess the changes in 5-yr CS rates after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) and to determine how well-established prognostic factors evolve over time. Design, setting, and participants We analysed data from 3544 patients treated with RNU at 15 international academic centres between 1989 and 2012. Intervention RNU. Outcomes measurements and statistical analysis Conditional intravesical recurrence-free (IVRFS), cancer-specific survival (CSS), and overall survival (OS) estimates were calculated using the Kaplan-Meier method. A multivariable Cox regression model was used to calculate proportional hazard ratios for the prediction of mortality. Results and limitations The 5-yr bladder cancer recurrence-free survival, CSS, and OS rates were 54.9{\%}, 72.2{\%}, and 62.6{\%}, respectively. Given a 1-, 2-, 3-, and 4-yr survivorship, the 5-yr conditional OS rates improved to 65.2{\%}, 69.3{\%}, 71.5{\%}, and 73.0{\%}, respectively. The 5-yr CS improvement was primarily noted among surviving patients with advanced-stage disease. The impact of pathologic parameters on CS estimates decreased over time for both CSS and OS, whereas the impact of age and gender increased with survivorship. No survival benefit was noted regarding the adjuvant chemotherapy status. Findings were confirmed upon multivariable analyses. Tumour location, the presence of carcinoma in situ, and the type of bladder cuff excision were continuously predictive for IVRFS whatever the survivorship. A limitation is the retrospective design. Conclusions CS analysis demonstrates that the patient risk profile evolves during the post-RNU follow-up. The probability of survival markedly increases over time in patients having high-stage disease. The impact of prognostic pathologic features decreases over time and can disappear for long-term CS. Patient summary In this study, we found that the risk of intravesical recurrence, cancer-specific survival, and overall mortality evolves over the follow-up after surgery. Taking into account the survivorship provides better estimates of the survival probability at each follow-up time.",
keywords = "Bladder cancer, Outcomes, Radical nephroureterectomy, Recurrence, Survival, Upper urinary tract carcinoma",
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T1 - Conditional survival after radical nephroureterectomy for upper tract carcinoma

AU - Ploussard, Guillaume

AU - Xylinas, Evanguelos

AU - Lotan, Yair

AU - Novara, Giacomo

AU - Margulis, Vitaly

AU - Rouprêt, Morgan

AU - Matsumoto, Kazumasa

AU - Karakiewicz, Pierre I.

AU - Montorsi, Francesco

AU - Remzi, Mezut

AU - Seitz, Christian

AU - Scherr, Douglas S.

AU - Kapoor, Anil

AU - Fairey, Adrian S.

AU - Rendon, Ricardo

AU - Izawa, Jonathan

AU - Black, Peter C.

AU - Lacombe, Louis

AU - Shariat, Shahrokh F.

AU - Kassouf, Wassim

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Background Conditional survival (CS) provides better estimates of the survival probability at each follow-up time, and its usefulness has been proven in several solid malignancies. Objective To assess the changes in 5-yr CS rates after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) and to determine how well-established prognostic factors evolve over time. Design, setting, and participants We analysed data from 3544 patients treated with RNU at 15 international academic centres between 1989 and 2012. Intervention RNU. Outcomes measurements and statistical analysis Conditional intravesical recurrence-free (IVRFS), cancer-specific survival (CSS), and overall survival (OS) estimates were calculated using the Kaplan-Meier method. A multivariable Cox regression model was used to calculate proportional hazard ratios for the prediction of mortality. Results and limitations The 5-yr bladder cancer recurrence-free survival, CSS, and OS rates were 54.9%, 72.2%, and 62.6%, respectively. Given a 1-, 2-, 3-, and 4-yr survivorship, the 5-yr conditional OS rates improved to 65.2%, 69.3%, 71.5%, and 73.0%, respectively. The 5-yr CS improvement was primarily noted among surviving patients with advanced-stage disease. The impact of pathologic parameters on CS estimates decreased over time for both CSS and OS, whereas the impact of age and gender increased with survivorship. No survival benefit was noted regarding the adjuvant chemotherapy status. Findings were confirmed upon multivariable analyses. Tumour location, the presence of carcinoma in situ, and the type of bladder cuff excision were continuously predictive for IVRFS whatever the survivorship. A limitation is the retrospective design. Conclusions CS analysis demonstrates that the patient risk profile evolves during the post-RNU follow-up. The probability of survival markedly increases over time in patients having high-stage disease. The impact of prognostic pathologic features decreases over time and can disappear for long-term CS. Patient summary In this study, we found that the risk of intravesical recurrence, cancer-specific survival, and overall mortality evolves over the follow-up after surgery. Taking into account the survivorship provides better estimates of the survival probability at each follow-up time.

AB - Background Conditional survival (CS) provides better estimates of the survival probability at each follow-up time, and its usefulness has been proven in several solid malignancies. Objective To assess the changes in 5-yr CS rates after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) and to determine how well-established prognostic factors evolve over time. Design, setting, and participants We analysed data from 3544 patients treated with RNU at 15 international academic centres between 1989 and 2012. Intervention RNU. Outcomes measurements and statistical analysis Conditional intravesical recurrence-free (IVRFS), cancer-specific survival (CSS), and overall survival (OS) estimates were calculated using the Kaplan-Meier method. A multivariable Cox regression model was used to calculate proportional hazard ratios for the prediction of mortality. Results and limitations The 5-yr bladder cancer recurrence-free survival, CSS, and OS rates were 54.9%, 72.2%, and 62.6%, respectively. Given a 1-, 2-, 3-, and 4-yr survivorship, the 5-yr conditional OS rates improved to 65.2%, 69.3%, 71.5%, and 73.0%, respectively. The 5-yr CS improvement was primarily noted among surviving patients with advanced-stage disease. The impact of pathologic parameters on CS estimates decreased over time for both CSS and OS, whereas the impact of age and gender increased with survivorship. No survival benefit was noted regarding the adjuvant chemotherapy status. Findings were confirmed upon multivariable analyses. Tumour location, the presence of carcinoma in situ, and the type of bladder cuff excision were continuously predictive for IVRFS whatever the survivorship. A limitation is the retrospective design. Conclusions CS analysis demonstrates that the patient risk profile evolves during the post-RNU follow-up. The probability of survival markedly increases over time in patients having high-stage disease. The impact of prognostic pathologic features decreases over time and can disappear for long-term CS. Patient summary In this study, we found that the risk of intravesical recurrence, cancer-specific survival, and overall mortality evolves over the follow-up after surgery. Taking into account the survivorship provides better estimates of the survival probability at each follow-up time.

KW - Bladder cancer

KW - Outcomes

KW - Radical nephroureterectomy

KW - Recurrence

KW - Survival

KW - Upper urinary tract carcinoma

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