title: Oncological outcomes after radical nephroureterectomy for upper tract urothelial carcinoma: comparison over the three decades.
abstract: OBJECTIVE
  To evaluate temporal trends in clinicopathological features and oncological outcomes after radical nephroureterectomy for upper tract urothelial carcinoma.
  
  
  METHODS
  Utilizing a multi-institutional database of patients treated with radical nephroureterectomy between 1983 and 2007, we compared clinicopathological features and survival outcomes over the past three decades using the following cohorts: group 1 comprised of patients treated before the 1990s (n = 106), group 2 from 1990 to1999 (n = 655), and group 3 from 2000 to 2007 (n = 701). Survival rates were compared using Kaplan-Meier survival analysis.
  
  
  RESULTS
  The study included 1462 patients, 992 men and 470 women, with 36 months median follow up (range 1-250 months) after radical nephroureterectomy. Tumors were organ confined (≤T2/N0) in 88% and high-grade in 64%. Neoadjuvant and adjuvant systemic chemotherapy was administered in 47 (3.2%) and 171 (11.7%) patients, respectively. There was a significant increase in the use of laparoscopic radical nephroureterectomy, endoscopic management of urothelial carcinoma and utilization of perioperative chemotherapy between decades 1 to 3. There were no significant differences in pathological stage distribution. The overall 5-year disease-free survival rates were 66 ± 5%, 68.5 ± 2% and 71 ± 2%, and the 5-year cancer-specific survival rates were 75 ± 5%, 72 ± 2%, and 75 ± 2% for groups 1, 2 and 3, respectively, with no significant statistical differences between the three decades (P > 0.05).
  
  
  CONCLUSIONS
  Outcomes after radical nephroureterectomy have not changed significantly over the past three decades, despite staging and surgical refinements. Utilization of perioperative systemic chemotherapy in urothelial carcinoma management remains low. Further improvements in outcomes of urothelial carcinoma patients necessitate rigorous investigation of multimodal treatment approaches.
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, TX 75390-9110, USA.
authors.forename: Mehrad
authors.initials: M
authors.lastname: Adibi
authors.forename: Ramy
authors.initials: R
authors.lastname: Youssef
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
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: 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; D002277:Carcinoma / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000639:trends; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000628:therapy*; D010535:Laparoscopy / Q000639:trends; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000639:trends; D009392:Nephrectomy; D015996:Survival Rate / Q000639:trends; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000628:therapy*; D018666:Ureteroscopy / Q000639:trends