The impact of tumor size on outcomes in patients with upper urinary tract urothelial carcinoma.
OBJECTIVE
To investigate the association between tumor size and clinicopathologic factors and outcomes of upper urinary tract urothelial carcinoma (UTUC) in patients treated surgically for UTUC.


METHODS
A single-center series of 235 consecutive patients who were treated surgically for UTUC between January 1999 and December 2011 was evaluated. Patients with a history of muscle-invasive urothelial carcinoma of the urinary bladder, those who received neoadjuvant therapies, and those with previous contralateral UTUC were excluded. Bladder-only recurrence, any recurrence, and cancer-specific mortality after surgery were analyzed. Recurrence-free probabilities and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method and Cox regression analyses.


RESULTS
Tumor size was significantly associated with age of the patient (P = 0.001), tumor location (P < 0.0001), tumor multifocality (P = 0.005), higher tumor stage (P < 0.0001), higher tumor grade (P = 0.038), lymphovascular invasion (P = 0.002), and mode of operation (P = 0.001). Tumor size was not associated with bladder-only recurrence (HR 0.91; 95% CI 0.46-1.80; P = 0.79). The Kaplan-Meier method showed that tumor size >3 cm was significantly associated with worse CSS (P = 0.006, log rank). The 5-year CSS for patients with tumor size ≤ 3 cm was 70.1% and for patients with tumor size >3 cm was 56.1%. Tumor size was not associated with cancer-specific survival in multivariable analysis (HR 1.53; 95% CI 0.89-2.61; P = 0.12).


CONCLUSIONS
Tumor size >3 cm was associated with a lower 5-year CSS at Kaplan-Meier analysis, but was not an independent predictor of CSS, bladder-only recurrence, and any recurrence-free survival at multivariable analysis.
Clinic of Urology, Clinical Center of Serbia, School of Medicine University of Belgrade, Resavska 51, 11000, Belgrade, Serbia, mp.dragica@ikomline.net.
Dragica
D
Milenkovic-Petronic
Bogomir
B
Milojevic
Milan
M
Djokic
Sandra
S
Sipetic-Grujicic
Isidora Grozdic
IG
Milojevic
Uros
U
Bumbasirevic
Zoran
Z
Dzamic
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*