title: Nephroureterectomy and segmental ureterectomy in the treatment of invasive upper tract urothelial carcinoma: a population-based study of 2299 patients.
abstract: OBJECTIVE
  The TNM staging system represents the cornerstone for classifying patients with upper tract urothelial carcinoma (UTUC). We tested the prognostic impact of pT and pN stages on cancer-specific mortality (CSM) in a large population-based cohort of surgically treated patients with UTUC.
  
  
  METHODS
  Our analyses relied on 2299 patients treated with nephroureterectomy (NU) or segmental ureterectomy (SU) for UTUC within nine Surveillance, Epidemiology and End Results registries between 1988 and 2004. CSM rates after surgery were graphically explored using Kaplan-Meier plots. Univariable and multivariable Cox regression models tested the effect of pT and pN stages on CSM, after adjusting for tumour grade, age, gender, primary tumour location, type and year of surgery.
  
  
  RESULTS
  Five years after surgery, the overall CSM-free survival rate was 77.6%. The 5-year CSM-free survival rates of pT(1)N(0) (n=739), pT(2)N(0) (n=422), pT(3)N(0) (n=691), pT(4)N(0) (n=190) and any T N(1-3) (n=257) were, respectively, 93.5 versus 86.2 versus 64.5 versus 54.7 versus 35.0%. The 5-year CSM-free survival rates of pT(1-2)N(1-3) (n=41) and pT(3-4)N(1-3) (n=216) patients were, respectively, 68.9% and 28.7% (p=0.006). In multivariable analyses, pT and pN stages (p<0.001), as well as tumour grade (p<0.001), achieved independent predictor status. Advanced age adversely affected CSM-free survival (p=0.001). Conversely, tumour location, gender, year and type of surgery did not exert independent predictor status.
  
  
  CONCLUSIONS
  Durable cancer control can be expected in patients treated with NU or SU for organ-confined (pT(1-2)) UTUC. Conversely, the presence of non-organ-confined (pT(3-4)) disease and/or of nodal metastases (pN(1-3)) exerts a profound detrimental effect on CSM-free survival.
authors.affiliation: Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada, H2X 3J4.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lughezzani
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Ahmed
authors.initials: A
authors.lastname: Alasker
authors.forename: Daniel
authors.initials: D
authors.lastname: Pharand
authors.forename: Hugues
authors.initials: H
authors.lastname: Widmer
authors.forename: Philippe
authors.initials: P
authors.lastname: Arjane
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D006306:Health Surveys; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000401:mortality*; D011379:Prognosis; D012042:Registries; D018426:SEER Program; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery