title: Urothelial carcinoma at the uretero-enteric junction: multi-center evaluation of oncologic outcomes after radical nephroureterectomy.
abstract: OBJECTIVE
  The natural history of urothelial carcinoma arising at the uretero-enteric junction (UEJ) is poorly defined, and the data guiding clinical management of these patients is limited. Therefore, we evaluated oncologic outcomes of patients treated for urothelial carcinoma at the UEJ.
  
  
  METHODS
  Utilizing a multi-institutional database of patients treated with radical nephroureterectomy (RNU), we assessed the clinicopathologic parameters and oncologic outcomes of UEJ tumors compared with other upper tract urothelial carcinomas (UTUC). Survival analyses were performed to determine independent predictors of disease recurrence and cancer-specific mortality after RNU.
  
  
  RESULTS
  The study included 1,363 patients, 921 men and 442 women with 36 months median follow-up after RNU. Compared with UTUC in the kidney or ureter, UEJ tumors (n = 22) were more likely to demonstrate features of advanced disease, which were proved to be independent predictors of disease recurrence and cancer-specific mortality after RNU. The 5 year disease-free survival (DFS) and cancer-specific survival (CSS) rates were 25% and 39% in those with UEJ tumors vs. 69% and 73% in those with UTUC in the kidney or ureter (P = 0.001 and P = 0.008, respectively).
  
  
  CONCLUSIONS
  UEJ tumors harbor features of locally advanced disease associated with high risk of systemic recurrence and death from cancer after RNU. Our findings suggest the need for integration of systemic therapy into the management paradigm of these patients.
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
authors.forename: Ramy F
authors.initials: RF
authors.lastname: Youssef
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Nicholas
authors.initials: N
authors.lastname: Cost
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Chromecki
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009392:Nephrectomy / Q000379:methods; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012007:Rectum / Q000473:pathology* / Q000601:surgery; D012307:Risk Factors; D013997:Time Factors; D014513:Ureter / Q000473:pathology* / Q000601:surgery; D014571:Urologic Neoplasms / Q000473:pathology* / Q000601:surgery