Impact of Tumor Location on Prognosis for Patients with Upper Tract Urothelial Carcinoma Managed by Radical Nephroureterectomy

Jay D. Raman, Casey K. Ng, Douglas S. Scherr, Vitaly Margulis, Yair Lotan, Karim Bensalah, Jean Jacques Patard, Eiji Kikuchi, Francesco Montorsi, Richard Zigeuner, Alon Weizer, Christian Bolenz, Theresa M. Koppie, Hendrik Isbarn, Claudio Jeldres, Wareef Kabbani, Mesut Remzi, Mathias Waldert, Christopher G. Wood, Marco RoscignoMototsuga Oya, Cord Langner, J. Stuart Wolf, Philipp Ströbel, Mario Fernández, Pierre Karakiewcz, Shahrokh F. Shariat

Research output: Contribution to journalArticle

116 Citations (Scopus)

Abstract

Background: There is a lack of consensus regarding the prognostic significance of ureteral versus renal pelvic upper tract urothelial carcinoma (UTUC). Objective: To investigate the association of tumor location on outcomes for UTUC in an international cohort of patients managed by radical nephroureterectomy (RNU). Design, setting, and participants: A retrospective review of institutional databases from 10 institutions worldwide identified patients with UTUC. Intervention: The 1249 patients in the study underwent RNU with ipsilateral bladder cuff resection between 1987 and 2007. Measurements: Data accrued included age, gender, race, surgical approach (open vs laparoscopic), tumor pathology (stage, grade, lymph node status), tumor location, use of perioperative chemotherapy, prior endoscopic therapy, urothelial carcinoma recurrence, and mortality from urothelial carcinoma. Tumor location was divided into two groups (renal pelvis and ureter) based on the location of the dominant tumor. Results and limitations: The 5-yr recurrence-free and cancer-specific survival estimates for this cohort were 75% and 78%, respectively. On multivariate analysis, only pathologic tumor (pT) classification (p < 0.001), grade (p < 0.02), and lymph node status (p < 0.001) were associated with disease recurrence and cancer-specific survival. When adjusting for these variables, there was no difference in the probability of disease recurrence (hazard ratio [HR]: 1.22; p = 0.133) or cancer death (HR: 1.23; p = 0.25) between ureteral and renal pelvic tumors. Adding tumor location to a base prognostic model for disease recurrence and cancer death that included pT stage, tumor grade, and lymph node status only improved the predictive accuracy of this model by 0.1%. This study is limited by biases associated with its retrospective design. Conclusions: There is no difference in outcomes between patients with renal pelvic tumors and with ureteral tumors following nephroureterectomy. These data support the current TNM staging system, whereby renal pelvic and ureteral carcinomas are classified as one integral group of tumors.

Original languageEnglish (US)
Pages (from-to)1072-1079
Number of pages8
JournalEuropean Urology
Volume57
Issue number6
DOIs
StatePublished - Jun 2010

Fingerprint

Carcinoma
Neoplasms
Recurrence
Kidney
Lymph Nodes
Kidney Pelvis
Survival
Neoplasm Staging
Ureter
Urinary Bladder
Multivariate Analysis
Databases
Pathology
Drug Therapy
Mortality

Keywords

  • Recurrence
  • Renal pelvis
  • Survival
  • Ureter
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Impact of Tumor Location on Prognosis for Patients with Upper Tract Urothelial Carcinoma Managed by Radical Nephroureterectomy. / Raman, Jay D.; Ng, Casey K.; Scherr, Douglas S.; Margulis, Vitaly; Lotan, Yair; Bensalah, Karim; Patard, Jean Jacques; Kikuchi, Eiji; Montorsi, Francesco; Zigeuner, Richard; Weizer, Alon; Bolenz, Christian; Koppie, Theresa M.; Isbarn, Hendrik; Jeldres, Claudio; Kabbani, Wareef; Remzi, Mesut; Waldert, Mathias; Wood, Christopher G.; Roscigno, Marco; Oya, Mototsuga; Langner, Cord; Wolf, J. Stuart; Ströbel, Philipp; Fernández, Mario; Karakiewcz, Pierre; Shariat, Shahrokh F.

In: European Urology, Vol. 57, No. 6, 06.2010, p. 1072-1079.

Research output: Contribution to journalArticle

Raman, JD, Ng, CK, Scherr, DS, Margulis, V, Lotan, Y, Bensalah, K, Patard, JJ, Kikuchi, E, Montorsi, F, Zigeuner, R, Weizer, A, Bolenz, C, Koppie, TM, Isbarn, H, Jeldres, C, Kabbani, W, Remzi, M, Waldert, M, Wood, CG, Roscigno, M, Oya, M, Langner, C, Wolf, JS, Ströbel, P, Fernández, M, Karakiewcz, P & Shariat, SF 2010, 'Impact of Tumor Location on Prognosis for Patients with Upper Tract Urothelial Carcinoma Managed by Radical Nephroureterectomy', European Urology, vol. 57, no. 6, pp. 1072-1079. https://doi.org/10.1016/j.eururo.2009.07.002
Raman, Jay D. ; Ng, Casey K. ; Scherr, Douglas S. ; Margulis, Vitaly ; Lotan, Yair ; Bensalah, Karim ; Patard, Jean Jacques ; Kikuchi, Eiji ; Montorsi, Francesco ; Zigeuner, Richard ; Weizer, Alon ; Bolenz, Christian ; Koppie, Theresa M. ; Isbarn, Hendrik ; Jeldres, Claudio ; Kabbani, Wareef ; Remzi, Mesut ; Waldert, Mathias ; Wood, Christopher G. ; Roscigno, Marco ; Oya, Mototsuga ; Langner, Cord ; Wolf, J. Stuart ; Ströbel, Philipp ; Fernández, Mario ; Karakiewcz, Pierre ; Shariat, Shahrokh F. / Impact of Tumor Location on Prognosis for Patients with Upper Tract Urothelial Carcinoma Managed by Radical Nephroureterectomy. In: European Urology. 2010 ; Vol. 57, No. 6. pp. 1072-1079.
@article{8d7015bd34d1495b9446ca9bc7524c32,
title = "Impact of Tumor Location on Prognosis for Patients with Upper Tract Urothelial Carcinoma Managed by Radical Nephroureterectomy",
abstract = "Background: There is a lack of consensus regarding the prognostic significance of ureteral versus renal pelvic upper tract urothelial carcinoma (UTUC). Objective: To investigate the association of tumor location on outcomes for UTUC in an international cohort of patients managed by radical nephroureterectomy (RNU). Design, setting, and participants: A retrospective review of institutional databases from 10 institutions worldwide identified patients with UTUC. Intervention: The 1249 patients in the study underwent RNU with ipsilateral bladder cuff resection between 1987 and 2007. Measurements: Data accrued included age, gender, race, surgical approach (open vs laparoscopic), tumor pathology (stage, grade, lymph node status), tumor location, use of perioperative chemotherapy, prior endoscopic therapy, urothelial carcinoma recurrence, and mortality from urothelial carcinoma. Tumor location was divided into two groups (renal pelvis and ureter) based on the location of the dominant tumor. Results and limitations: The 5-yr recurrence-free and cancer-specific survival estimates for this cohort were 75{\%} and 78{\%}, respectively. On multivariate analysis, only pathologic tumor (pT) classification (p < 0.001), grade (p < 0.02), and lymph node status (p < 0.001) were associated with disease recurrence and cancer-specific survival. When adjusting for these variables, there was no difference in the probability of disease recurrence (hazard ratio [HR]: 1.22; p = 0.133) or cancer death (HR: 1.23; p = 0.25) between ureteral and renal pelvic tumors. Adding tumor location to a base prognostic model for disease recurrence and cancer death that included pT stage, tumor grade, and lymph node status only improved the predictive accuracy of this model by 0.1{\%}. This study is limited by biases associated with its retrospective design. Conclusions: There is no difference in outcomes between patients with renal pelvic tumors and with ureteral tumors following nephroureterectomy. These data support the current TNM staging system, whereby renal pelvic and ureteral carcinomas are classified as one integral group of tumors.",
keywords = "Recurrence, Renal pelvis, Survival, Ureter, Urothelial carcinoma",
author = "Raman, {Jay D.} and Ng, {Casey K.} and Scherr, {Douglas S.} and Vitaly Margulis and Yair Lotan and Karim Bensalah and Patard, {Jean Jacques} and Eiji Kikuchi and Francesco Montorsi and Richard Zigeuner and Alon Weizer and Christian Bolenz and Koppie, {Theresa M.} and Hendrik Isbarn and Claudio Jeldres and Wareef Kabbani and Mesut Remzi and Mathias Waldert and Wood, {Christopher G.} and Marco Roscigno and Mototsuga Oya and Cord Langner and Wolf, {J. Stuart} and Philipp Str{\"o}bel and Mario Fern{\'a}ndez and Pierre Karakiewcz and Shariat, {Shahrokh F.}",
year = "2010",
month = "6",
doi = "10.1016/j.eururo.2009.07.002",
language = "English (US)",
volume = "57",
pages = "1072--1079",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "6",

}

TY - JOUR

T1 - Impact of Tumor Location on Prognosis for Patients with Upper Tract Urothelial Carcinoma Managed by Radical Nephroureterectomy

AU - Raman, Jay D.

AU - Ng, Casey K.

AU - Scherr, Douglas S.

AU - Margulis, Vitaly

AU - Lotan, Yair

AU - Bensalah, Karim

AU - Patard, Jean Jacques

AU - Kikuchi, Eiji

AU - Montorsi, Francesco

AU - Zigeuner, Richard

AU - Weizer, Alon

AU - Bolenz, Christian

AU - Koppie, Theresa M.

AU - Isbarn, Hendrik

AU - Jeldres, Claudio

AU - Kabbani, Wareef

AU - Remzi, Mesut

AU - Waldert, Mathias

AU - Wood, Christopher G.

AU - Roscigno, Marco

AU - Oya, Mototsuga

AU - Langner, Cord

AU - Wolf, J. Stuart

AU - Ströbel, Philipp

AU - Fernández, Mario

AU - Karakiewcz, Pierre

AU - Shariat, Shahrokh F.

PY - 2010/6

Y1 - 2010/6

N2 - Background: There is a lack of consensus regarding the prognostic significance of ureteral versus renal pelvic upper tract urothelial carcinoma (UTUC). Objective: To investigate the association of tumor location on outcomes for UTUC in an international cohort of patients managed by radical nephroureterectomy (RNU). Design, setting, and participants: A retrospective review of institutional databases from 10 institutions worldwide identified patients with UTUC. Intervention: The 1249 patients in the study underwent RNU with ipsilateral bladder cuff resection between 1987 and 2007. Measurements: Data accrued included age, gender, race, surgical approach (open vs laparoscopic), tumor pathology (stage, grade, lymph node status), tumor location, use of perioperative chemotherapy, prior endoscopic therapy, urothelial carcinoma recurrence, and mortality from urothelial carcinoma. Tumor location was divided into two groups (renal pelvis and ureter) based on the location of the dominant tumor. Results and limitations: The 5-yr recurrence-free and cancer-specific survival estimates for this cohort were 75% and 78%, respectively. On multivariate analysis, only pathologic tumor (pT) classification (p < 0.001), grade (p < 0.02), and lymph node status (p < 0.001) were associated with disease recurrence and cancer-specific survival. When adjusting for these variables, there was no difference in the probability of disease recurrence (hazard ratio [HR]: 1.22; p = 0.133) or cancer death (HR: 1.23; p = 0.25) between ureteral and renal pelvic tumors. Adding tumor location to a base prognostic model for disease recurrence and cancer death that included pT stage, tumor grade, and lymph node status only improved the predictive accuracy of this model by 0.1%. This study is limited by biases associated with its retrospective design. Conclusions: There is no difference in outcomes between patients with renal pelvic tumors and with ureteral tumors following nephroureterectomy. These data support the current TNM staging system, whereby renal pelvic and ureteral carcinomas are classified as one integral group of tumors.

AB - Background: There is a lack of consensus regarding the prognostic significance of ureteral versus renal pelvic upper tract urothelial carcinoma (UTUC). Objective: To investigate the association of tumor location on outcomes for UTUC in an international cohort of patients managed by radical nephroureterectomy (RNU). Design, setting, and participants: A retrospective review of institutional databases from 10 institutions worldwide identified patients with UTUC. Intervention: The 1249 patients in the study underwent RNU with ipsilateral bladder cuff resection between 1987 and 2007. Measurements: Data accrued included age, gender, race, surgical approach (open vs laparoscopic), tumor pathology (stage, grade, lymph node status), tumor location, use of perioperative chemotherapy, prior endoscopic therapy, urothelial carcinoma recurrence, and mortality from urothelial carcinoma. Tumor location was divided into two groups (renal pelvis and ureter) based on the location of the dominant tumor. Results and limitations: The 5-yr recurrence-free and cancer-specific survival estimates for this cohort were 75% and 78%, respectively. On multivariate analysis, only pathologic tumor (pT) classification (p < 0.001), grade (p < 0.02), and lymph node status (p < 0.001) were associated with disease recurrence and cancer-specific survival. When adjusting for these variables, there was no difference in the probability of disease recurrence (hazard ratio [HR]: 1.22; p = 0.133) or cancer death (HR: 1.23; p = 0.25) between ureteral and renal pelvic tumors. Adding tumor location to a base prognostic model for disease recurrence and cancer death that included pT stage, tumor grade, and lymph node status only improved the predictive accuracy of this model by 0.1%. This study is limited by biases associated with its retrospective design. Conclusions: There is no difference in outcomes between patients with renal pelvic tumors and with ureteral tumors following nephroureterectomy. These data support the current TNM staging system, whereby renal pelvic and ureteral carcinomas are classified as one integral group of tumors.

KW - Recurrence

KW - Renal pelvis

KW - Survival

KW - Ureter

KW - Urothelial carcinoma

UR - http://www.scopus.com/inward/record.url?scp=77951623665&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77951623665&partnerID=8YFLogxK

U2 - 10.1016/j.eururo.2009.07.002

DO - 10.1016/j.eururo.2009.07.002

M3 - Article

C2 - 19619934

AN - SCOPUS:77951623665

VL - 57

SP - 1072

EP - 1079

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 6

ER -