Risk of cancer-specific mortality following recurrence after radical nephroureterectomy.
OBJECTIVE
To describe the natural history and identify predictors of cancer-specific survival in patients who experience disease recurrence after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).


METHODS
Of 2,494 UTUC patients treated with RNU without neoadjuvant chemotherapy, 597 patients experienced disease recurrence. A total of 148 patients (25 %) received adjuvant chemotherapy before disease recurrence. Multivariable Cox regression model addressed time to cancer-specific mortality after disease recurrence.


RESULTS
The median time from RNU to disease recurrence was 12 months (interquartile range 5-22). A total of 491 (82 %) of 597 patients died from UTUC, and 8 patients (1.3 %) died from other causes. The median time from disease recurrence to death of UTUC was 10 months. Actuarial cancer-specific survival estimate at 12 months after disease recurrence was 35 %. On multivariable analysis that adjusted for the effects of standard clinicopathologic characteristics, higher tumor stages [hazard ratio (HR) pT3 vs. pT0-T1: 1.66, p = 0.001; HR pT4 vs. pT0-T1: 1.90, p = 0.002], absence of lymph node dissection (HR 1.28, p = 0.041), ureteral tumor location (HR 1.44, p < 0.0005) and a shorter interval from surgery to disease recurrence (p < 0.0005) were significantly associated with cancer-specific mortality. The adjusted 6-, 12- and 24-month postrecurrence cancer-specific mortality was 73, 60 and 57 %, respectively.


CONCLUSIONS
Approximately 80 % of patients who experience disease recurrence after RNU die within 2 years after recurrence. Patients with non-organ-confined stage, absence of lymph node dissection, ureteral tumor location and/or shorter time to disease recurrence died of their tumor more quickly than their counterparts. These factors should be considered in patient counseling and risk stratification for salvage treatment decision making.
Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA. mrink@uke.uni-hamburg.de
Michael
M
Rink
Daniel
D
Sjoberg
Evi
E
Comploj
Vitaly
V
Margulis
Evanguelos
E
Xylinas
Richard K
RK
Lee
Jens
J
Hansen
Eugene K
EK
Cha
Jay D
JD
Raman
Mesut
M
Remzi
Karim
K
Bensalah
Giacomo
G
Novara
Surena F
SF
Matin
Felix K
FK
Chun
Eiji
E
Kikuchi
Wassim
W
Kassouf
Juan I
JI
Martinez-Salamanca
Yair
Y
Lotan
Christian
C
Seitz
Armin
A
Pycha
Richard
R
Zigeuner
Pierre I
PI
Karakiewicz
Douglas S
DS
Scherr
Andrew J
AJ
Vickers
Shahrokh F
SF
Shariat
D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014516:Ureteral Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery