Effect of tumor size on recurrence-free survival of upper tract urothelial carcinoma following surgical resection.
OBJECTIVE
To identify predictors of recurrence-free survival (RFS) based on the clinicopathological features of patients with upper tract urothelial carcinoma (UTUC) who have undergone radical nephroureterectomy (RNU) with bladder cuff resection.


METHODS
We retrospectively reviewed the records of patients from October 1998 to July 2012 at our tertiary institution and identified 120 patients with sufficient data who underwent RNU for UTUC. We recorded various clinical and histopathological parameters as potential predictors of outcome. Recurrence was defined as any occurrence of urothelial carcinoma after RNU either intravesically, local/regionally, or at distant sites. Univariate, multivariate, and RFS analyses were conducted using the Cox regression and Kaplan-Meier methods.


RESULTS
The median age of our cohort was 71 years (interquartile range: 64-78). Median RNU-specimen tumor size was 3.0 cm (interquartile range: 2.0-5.0 cm). Fifty-four patients (45%) had a tumor<3.0 cm and 66 (55%) had a tumor≥3.0 cm. Eighty patients (66.7%) had organ-confined UTUC (≤pT2) and 40 (33.3%) had non-organ-confined UTUC (≥pT3). Sixty-five patients (54.2%) experienced at least 1 recurrence. Forty-three patients (35.8%) had at least 1 episode of intravesical recurrence and 28 (23.3%) had distant recurrence. A multivariate analysis revealed non-organ-confined disease (hazard ratio [HR] = 3.62, P<0.001), tumor diameter≥3 cm (HR = 1.97, P = 0.011), and male gender (HR = 1.81, P = 0.047) to be significant independent predictors of disease recurrence. The 5-year RFS rate was 46.9% and 25.8% for patients with tumor size<3 and ≥3 cm, respectively.


CONCLUSIONS
Following RNU, the incidence of recurrence remains high among patients with UTUC. In our cohort of patients, tumor diameter≥3.0 cm, non-organ-confined UTUC, and male gender constitute important risk factors for poor RFS outcomes following RNU. These patients require diligent postoperative surveillance and may potentially benefit from perioperative systemic therapy.
Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
Patrick N
PN
Espiritu
Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
Einar F
EF
Sverrisson
Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
Wade J
WJ
Sexton
Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
Julio M
JM
Pow-Sang
Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
Michael A
MA
Poch
Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, FL.
Jasreman
J
Dhillon
Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL. Electronic address: philippe.spiess@moffitt.org.
Philippe E
PE
Spiess
D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000473:pathology* / Q000601:surgery*; D019459:Urothelium / Q000473:pathology*
Pathology; Recurrence; Risk factors; Tumor size; Upper tract urothelial carcinoma