title: Multifocality rather than tumor location is a prognostic factor in upper tract urothelial carcinoma.
abstract: OBJECTIVE
  Whether a patient has urothelial carcinoma located within the renal pelvis or ureter remains a controversial prognostic indicator in clinical urology. We wished to evaluate whether tumor location is associated with recurrence in patients undergoing nephroureterectomy for upper tract urothelial cancer in a large volume patient cohort.
  
  
  METHODS
  We created a retrospective database of patients from 7 academic centers throughout Canada who underwent nephroureterectomy for upper tract urothelial carcinoma. Patient demographics as well as pathologic and surgical factors were analyzed to evaluate any statistical association between tumor location and overall survival, disease-free survival, and disease-specific survival.
  
  
  RESULTS
  A total of 1,029 patients had data available for analysis with a mean follow up of 3.2 years. Kaplan Meier 5-year disease-free survivals (DFS) were 46%, 37%, and 19% for renal pelvis tumors, ureteric tumors, and multifocal tumors respectively. There was no association between the location of the tumor and the DFS, however, disease involving both the ureter and renal pelvis was associated with lower DFS and overall survival (OS) (P < 0.001).
  
  
  CONCLUSIONS
  Tumor location does not appear to have any influence on the risk of recurrence of disease following nephroureterectomy in this large patient cohort. However, multifocal tumors involving both the ureter and renal pelvis had a significantly worse prognosis and should be considered for more aggressive management.
authors: Division of Urology, Department of Surgery and Oncology, UWO, London, Ontario, Canada.
authors: Andrew K
authors: AK
authors: Williams
authors: Wassim
authors: W
authors: Kassouf
authors: Joseph
authors: J
authors: Chin
authors: Ricardo
authors: R
authors: Rendon
authors: Niels
authors: N
authors: Jacobsen
authors: Adrian
authors: A
authors: Fairey
authors: Anil
authors: A
authors: Kapoor
authors: Peter
authors: P
authors: Black
authors: Louis
authors: L
authors: Lacombe
authors: Simon
authors: S
authors: Tanguay
authors: Alan
authors: A
authors: So
authors: Jean-Baptiste
authors: JB
authors: Lattouf
authors: David
authors: D
authors: Bell
authors: Yves
authors: Y
authors: Fradet
authors: Fred
authors: F
authors: Saad
authors: Ed
authors: E
authors: Matsumoto
authors: Darrel
authors: D
authors: Drachenberg
authors: Ilias
authors: I
authors: Cagiannos
authors: Jonathan I
authors: JI
authors: Izawa
mesh_terms: D000368:Aged; D002170:Canada; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D007682:Kidney Pelvis / Q000473:pathology / Q000601:surgery; D008297:Male; D015999:Multivariate Analysis; D009392:Nephrectomy; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology / Q000601:surgery; D014516:Ureteral Neoplasms / Q000473:pathology* / Q000601:surgery; D014571:Urologic Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: Carcinoma; Nephro-ureterectomy; Renal pelvis; Ureter; Urothelial