title: Impact of tumour location and surgical approach on recurrence-free and cancer-specific survival analysis in patients with ureteric tumours.
abstract: What's known on the subject? and What does the study add? Pathological stage, lymph node metastasis and tumour grade have been established as prognostic factors for upper-tract urothelial carcinoma, but there are few studies to date assessing location within the ureter as a prognostic factor. There are also few studies comparing surgical approaches to radical nephroureterectomy (NU), partial ureterectomy and endoscopic resection (ENDO) with regard to oncological outcomes. This study did not find any prognostic significance for tumour location or surgical approach with regard to outcomes in patients with ureteric tumours. Although NU is the standard treatment for invasive ureteric tumours, partial ureterectomy and ENDO can safely be performed in selected patients. Despite the risk of a shorter time to recurrence, ENDO can be recommended in low grade, non-invasive ureteric tumours but only with close, thorough surveillance practices.
  
  
  OBJECTIVE
  • To assess the impact of tumour location within the ureter and the impact of surgical approach on recurrence-free survival (RFS) and cancer-specific survival (CSS) with regard to ureteric tumours.
  
  
  METHODS
  • Data were retrospectively reviewed from 60 patients with isolated primary ureteric tumours, treated at a single tertiary referral centre. • Patients were treated with radical nephroureterectomy (NU, n= 33), partial ureterectomy (n= 17) or endoscopic resection (ENDO, n= 10). • Kaplan-Meier curves were used for the analysis of RFS and CSS after surgery, stratified by tumour location and surgical approach.
  
  
  RESULTS
  • With a median follow-up of 29 months, tumour location was not associated with disease recurrence (P= 0.423). • The ENDO group had shorter time to disease recurrence. • There were no significant differences in the probability of CSS with regard to either tumour location or surgical approach (P= 0.523 and P= 0.904, respectively).
  
  
  CONCLUSIONS
  • Tumour location or surgical approach were not significant predictors of oncological outcomes in patients with ureteric tumours. • Although NU is standard treatment for invasive ureteric tumours, partial ureterectomy and ENDO can safely be performed in selected patients. Despite the risk of a shorter time to recurrence, ENDO can be recommended in low grade, non-invasive ureteric tumours. • All urothelium-preserving approaches require thorough surveillance.
authors.affiliation: Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York, NY, USA.
authors.forename: Xu
authors.initials: X
authors.lastname: Bin
authors.forename: Ornob P
authors.initials: OP
authors.lastname: Roy
authors.forename: Eric
authors.initials: E
authors.lastname: Ghiraldi
authors.forename: Niti
authors.initials: N
authors.lastname: Manglik
authors.forename: Tang
authors.initials: T
authors.lastname: Liang
authors.forename: Manish
authors.initials: M
authors.lastname: Vira
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / 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; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D009518:New York / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014513:Ureter / Q000473:pathology / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D018666:Ureteroscopy / Q000379:methods*