title: Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration.
abstract: BACKGROUND
  The literature on upper tract urothelial carcinoma (UTUC) has been limited to small, single center studies. A large series of patients treated with radical nephroureterectomy for UTUC were studied, and variables associated with poor prognosis were identified.
  
  
  METHODS
  Data on 1363 patients treated with radical nephroureterectomy at 12 academic centers were collected. All pathologic slides were re-reviewed by genitourinary pathologists according to strict criteria.
  
  
  RESULTS
  Pathologic review revealed renal pelvis location (64%), necrosis (21.6%), lymphovascular invasion (LVI) (24.8%), concomitant carcinoma in situ (28.7%), and high-grade disease (63.7%). A total of 590 patients (43.3%) underwent concurrent, lymphadenectomy and 135 (9.9%) were lymph node (LN) -positive. Over a mean follow-up of 51 months, 379 (28%) patients experienced disease recurrence outside of the bladder and 313 (23%) died of UTUC. The 5-year recurrence-free and cancer-specific survival probabilities (+/-SD) were 69%+/-1% and 73%+/-1%, respectively. On multivariate analysis, high tumor grade (hazards ratio [HR]: 2.0, P<.001), advancing pathologic T stage (P-for-trend<.001), LN metastases (HR: 1.8, P<.001), infiltrative growth pattern (HR: 1.5, P<.001), and LVI (HR: 1.2, P=.041) were associated with disease recurrence. Similarly, patient age (HR: 1.1, P=.001), high tumor grade (HR: 1.7, P=.001), increasing pathologic T stage (P-for-trend<.001), LN metastases (HR: 1.7, P<.001), sessile architecture (HR: 1.5, P=.002), and LVI (HR: 1.4, P=.02) were independently associated with cancer-specific survival.
  
  
  CONCLUSIONS
  Radical nephroureterectomy provided durable local control and cancer-specific survival in patients with localized UTUC. Pathologic tumor grade, T stage, LN status, tumor architecture, and LVI were important prognostic variables associated with oncologic outcomes, which could potentially be used to select patients for adjuvant systemic therapy.
authors.affiliation: Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Surena F
authors.initials: SF
authors.lastname: Matin
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Kamat
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Alon
authors.initials: A
authors.lastname: Weizer
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D015337:Multicenter Studies as Topic; D009364:Neoplasm Recurrence, Local; D009392:Nephrectomy; D011379:Prognosis; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000473:pathology / Q000601:surgery; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*