title: Survival after nephroureterectomy for upper tract urothelial carcinoma: a population-based competing-risks analysis.
abstract: OBJECTIVE
  To examine the rates of cancer-specific mortality, other-cause and bladder cancer mortality in patients with upper-tract urothelial carcinoma undergoing radical nephroureterectomy.
  
  
  METHODS
  Relying on the Surveillance, Epidemiology, and End Results database, 9899 patients treated with radical nephroureterectomy were identified. A 20-strata graphical aid was constructed using age (<60, 60-69, 70-79, >79 years) and American Joint Committee on Cancer/TNM stage (pT₁N₀/x , pT₂N₀/x , pT₃N₀/x , pT₄N₀/x , pTany pN₁₋₃) as stratifying variables. The 5-year cancer-specific mortality, other-cause and bladder cancer mortality rates were generated through competing-risks Poisson regression methodologies. Multivariable competing-risks regression models were used to test the effect of age and stage on three different end-points: cancer-specific mortality, other-cause and bladder cancer mortality.
  
  
  RESULTS
  Overall, 1797 (18.1%), 891 (9.1%) and 3090 (31.2%) patients died of cancer-specific mortality, other-cause and bladder cancer mortality, respectively. Following stratification according to age and stage, the proportion of patients who succumbed to cancer-specific mortality (11.7-21.9%) and other-cause mortality (8.9-30.4%) increased with age. In contrast, with increasing stage, the proportion of patients who died of cancer-specific mortality increased (7.2-37.5%), whereas the proportion of other-cause mortality remained stable (18.9-22.0%). The rate of bladder cancer mortality increased with advancing stage. At multivariable competing-risk regression model, besides age and stage, women, type of surgery, grade and location were associated with higher cancer-specific mortality. Furthermore, ureteral location, stage and grade were associated with bladder cancer mortality.
  
  
  CONCLUSIONS
  The developed graphical aid for prediction of cancer-specific mortality, other-cause, and bladder cancer mortality according to age and stage in patients with upper-tract urothelial carcinoma undergoing radical nephroureterectomy can be useful for physicians and patients during clinical counseling.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Andreas
authors.initials: A
authors.lastname: Becker
authors.forename: Alexandre
authors.initials: A
authors.lastname: Larouche
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000401:mortality* / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000401:mortality; D055815:Young Adult
keywords: bladder cancer mortality; cancer-specific mortality; competing-risks; nephroureterectomy; upper-tract urothelial carcinoma