Predictors of survival in patients with disease recurrence after radical nephroureterectomy.
OBJECTIVE
To evaluate the prognostic value of the Bajorin criteria in a multi-institutional cohort of patients with disease recurrence after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). To investigate whether clinical, pathological and/or biological factors at time of disease recurrence are also associated with cancer-specific outcomes in these patients.


METHODS
We identified 242 patients with disease recurrence after RNU for UTUC from 11 centres. With regard to the Bajorin criteria, patients were categorized into three groups based on two risk factors: Karnofsky performance status <80% and the presence of visceral metastasis. Assessed variables included pathological characteristics, time to disease recurrence, age-adjusted Charlson comorbidity index (ACCI), American Society of Anesthesiologists (ASA) score, and laboratory tests at time of disease recurrence.


RESULTS
Overall, 185 patients died from their disease; the median survival was 9 months. The survival rates at 1 year were 53, 33, and 39% for patients with no (n = 18), one (n = 109) and two (n = 115) risk factors, respectively, with no significant difference between the groups. In univariable analyses, higher pT-stage, tumour necrosis, non-administered salvage chemotherapy, higher ACCI score, higher ASA score, lower albumin level and higher white blood cell count were significantly associated with a shorter time to cancer-specific mortality.


CONCLUSIONS
We confirmed the poor yet variable outcomes of patients with disease recurrence after RNU. While the Bajorin criteria seem to have limited prognostic value in this specific cohort, we found several other clinical variables to be associated with worse cancer-specific mortality. If validated, these factors should be taken into consideration for clinical trial design.
Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
Luis A
LA
Kluth
Evanguelos
E
Xylinas
Matthew
M
Kent
Masayuki
M
Hagiwara
Eiji
E
Kikuchi
Masaomi
M
Ikeda
Kazumasa
K
Matsumoto
Orietta
O
Dalpiaz
Richard
R
Zigeuner
Atiqullah
A
Aziz
Hans-Martin
HM
Fritsche
Amanda
A
Deliere
Jay D
JD
Raman
Karim
K
Bensalah
Bikheet
B
Al-Matar
Georgios
G
Gakis
Giacomo
G
Novara
Tobias
T
Klatte
Mesut
M
Remzi
Evi
E
Comploj
Armin
A
Pycha
Morgan
M
Rouprêt
Scott T
ST
Tagawa
Felix K-H
FK
Chun
Douglas S
DS
Scherr
Andrew J
AJ
Vickers
Shahrokh F
SF
Shariat
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009392:Nephrectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014516:Ureteral Neoplasms / Q000401:mortality* / Q000601:surgery*
disease recurrence; metastasis; prognosis; survival; upper tract urothelial carcinoma; urothelial cancer