title: Influence of preoperative factors on the oncologic outcome for upper urinary tract urothelial carcinoma after radical nephroureterectomy.
abstract: OBJECTIVE
  To evaluate the influence of preoperative factors on the survival of patients diagnosed with upper tract urothelial carcinoma (UTUC) who underwent a radical nephroureterectomy (RNU).
  
  
  METHODS
  A multicentre retrospective study was performed on all patients with UTUC who underwent a RNU. Multiple preoperative criteria were tested as prognostic factors for cancer-specific survival (CSS) using univariate and multivariable Cox regression analyses.
  
  
  RESULTS
  Overall, 476 patients with a median age of 69.2 (IQR 60.8-76.5) years were included. The median follow-up was 27.8 months (IQR 10.5-49.3). At the time of diagnosis, 400 (84.1 %) patients presented with symptoms and 76 patients (15.9 %) were asymptomatic. Renal failure, altered general health, a preoperative locally advanced tumour and multifocal disease appeared to be preoperative prognostic factors for CSS (p = 0.01, 0.03, 0.001 and 0.03, respectively) in the univariate analysis. Only renal failure (p = 0.03), a preoperative locally advanced tumour (0.004), and multifocal locations (p = 0.01) were confirmed as independent factors of CSS in the multivariate analysis. The independent prognosticators of definitive muscle-invasive stage and non-organ-confined disease were preoperative renal failure (p = 0.02, 0.027, respectively), locally advanced stage (p < 0.001, <0.001, respectively) and positive cytology (p = 0.006, 0.003 respectively). Female gender was independent factor only for prediction of final non-organ-confined disease (p = 0.007). The addition of these parameters in our preoperative complex model permitted the prediction of muscle-invasive or locally advanced disease in 65.3 and 67.2 % of patients, respectively.
  
  
  CONCLUSIONS
  Patients with preoperative impaired renal function, locally advanced stage and multifocal tumours before RNU had worse survival outcomes compared to other patients.
authors.affiliation: Academic Department of Urology, Côte de Nacre Hospital, CHRU Caen, Caen, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Hurel
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.forename: Thomas
authors.initials: T
authors.lastname: Seisen
authors.forename: Eva
authors.initials: E
authors.lastname: Comperat
authors.forename: Véronique
authors.initials: V
authors.lastname: Phé
authors.forename: Stéphane
authors.initials: S
authors.lastname: Droupy
authors.forename: François
authors.initials: F
authors.lastname: Audenet
authors.forename: Géraldine
authors.initials: G
authors.lastname: Pignot
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
authors.forename: Laurent
authors.initials: L
authors.lastname: Guy
authors.forename: Olivier
authors.initials: O
authors.lastname: Cussenot
authors.forename: Adil
authors.initials: A
authors.lastname: Ouzzane
authors.forename: Gregory
authors.initials: G
authors.lastname: Bozzini
authors.forename: Laurent
authors.initials: L
authors.lastname: Nison
authors.forename: Alain
authors.initials: A
authors.lastname: Ruffion
authors.forename: Pierre
authors.initials: P
authors.lastname: Colin
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D057234:Preoperative Period; D011379:Prognosis; D012044:Regression Analysis; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014571:Urologic Neoplasms / Q000401:mortality* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*