title: Ureteral and multifocal tumours have worse prognosis than renal pelvic tumours in urothelial carcinoma of the upper urinary tract treated by nephroureterectomy.
abstract: BACKGROUND
  It is not known whether the primary tumour location of upper urinary tract urothelial carcinoma (UUT-UC) is associated with prognosis.
  
  
  OBJECTIVE
  To evaluate the impact of initial primary tumour location on survival in patients who had undergone radical nephroureterectomy (RNU).
  
  
  METHODS
  Using a multi-institutional, retrospective database, we identified 609 patients with UUT-UC who had undergone RNU between 1995 and 2010. Tumour location was categorised as renal pelvis, ureter, or multifocal.
  
  
  METHODS
  All patients had undergone RNU.
  
  
  METHODS
  Tumour location was tested as a prognostic factor for survival through univariate and multivariable Cox regression analysis.
  
  
  CONCLUSIONS
  Tumour location was renal pelvis in 317 cases (52%), ureter in 185 cases (30%), and multifocal in 107 cases (18%). Compared to renal pelvic and ureteral tumours, multifocal tumours were more likely to be associated with advanced stages (pT3/pT4; 39%, 30%, and 54%, respectively; p<0.001) and high-grade disease (53%, 56%, and 76%, respectively; p<0.001). On multivariable analysis, tumour location was an independent prognostic factor for cancer-specific death, disease recurrence, and metastasis (p<0.05). The 5-yr cancer-specific death-free survival probability was 86.8% for renal pelvic tumours, 68.9% for ureteral tumours, and 56.8% for multifocal tumours (p<0.001). The retrospective design of this study was its main limitation.
  
  
  CONCLUSIONS
  Ureteral and multifocal tumours had a worse prognosis than renal pelvic tumours. These findings are not in line with recently published data and should be investigated in a prospective assessment to obtain a definitive statement regarding this matter.
authors.affiliation: Academic Department of Urology, CHU Lille, Univ Lille Nord de France, F-59000 Lille, France. adil-ouzzane@orange.fr
authors.forename: Adil
authors.initials: A
authors.lastname: Ouzzane
authors.forename: Pierre
authors.initials: P
authors.lastname: Colin
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.forename: Geraldine
authors.initials: G
authors.lastname: Pignot
authors.forename: Mehdi Mokhtar
authors.initials: MM
authors.lastname: Ariane
authors.forename: Fabien
authors.initials: F
authors.lastname: Saint
authors.forename: Nicolas
authors.initials: N
authors.lastname: Hoarau
authors.forename: Emilie
authors.initials: E
authors.lastname: Adam
authors.forename: Marie Dominique
authors.initials: MD
authors.lastname: Azemar
authors.forename: Henri
authors.initials: H
authors.lastname: Bensadoun
authors.forename: Luc
authors.initials: L
authors.lastname: Cormier
authors.forename: Olivier
authors.initials: O
authors.lastname: Cussenot
authors.forename: Alain
authors.initials: A
authors.lastname: Houlgatte
authors.forename: Gilles
authors.initials: G
authors.lastname: Karsenty
authors.forename: Franck
authors.initials: F
authors.lastname: Bruyère
authors.forename: Charlotte
authors.initials: C
authors.lastname: Maurin
authors.forename: François Xavier
authors.initials: FX
authors.lastname: Nouhaud
authors.forename: Véronique
authors.initials: V
authors.lastname: Phe
authors.forename: Thomas
authors.initials: T
authors.lastname: Polguer
authors.forename: Mathieu
authors.initials: M
authors.lastname: Roumiguié
authors.forename: Alain
authors.initials: A
authors.lastname: Ruffion
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007682:Kidney Pelvis / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019459:Urothelium / Q000473:pathology / Q000601:surgery