title: Prognostic factors for upper urinary tract urothelial carcinoma after nephroureterectomy.
abstract: BACKGROUND
  The purpose of this study was to evaluate prognostic factors for patients with upper urinary tract urothelial carcinoma (UUT-UC) after nephroureterectomy and to seek a better way of finding more favorable clinical results for these patients.
  
  
  METHODS
  We retrospectively reviewed the medical records of 121 UUT-UC patients who underwent a nephroureterectomy at our institution, and analyzed the prognostic significance of various clinicopathological parameters for progression-free and disease-specific survival rates by using univariate and multivariate analysis.
  
  
  RESULTS
  A Cox proportional hazards model showed that extravesical tumor recurrence after surgery was an independent prognostic factor for disease-specific survival (p < 0.0001). An additional model showed that lymphovascular invasion (LVI) was one of the independent predictors of lower extravesical-recurrence-free survival rates (p = 0.0004). Our final finding was that pathological tumor stage and positive surgical margin were significantly associated with the presence of LVI (p < 0.0001 and p = 0.0029, respectively).
  
  
  CONCLUSIONS
  We conclude that there is a high possibility of LVI in patients with large tumors. Our findings should be helpful in terms of determining whether or not to perform neoadjuvant chemotherapy for patients with large tumors, given the fact that we frequently find a severe reduction in renal function after nephroureterectomy.
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Japan. kksmy@sa2.so-net.ne.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuroda
authors.forename: Junichi
authors.initials: J
authors.lastname: Asakuma
authors.forename: Akio
authors.initials: A
authors.lastname: Horiguchi
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Tasaki
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yoshii
authors.forename: Akinori
authors.initials: A
authors.lastname: Sato
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ito
authors.forename: Kenji
authors.initials: K
authors.lastname: Seguchi
authors.forename: Makoto
authors.initials: M
authors.lastname: Sumitomo
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Asano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D014513:Ureter / Q000473:pathology / Q000601:surgery*; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019459:Urothelium / Q000473:pathology / Q000601:surgery*