title: Extraurothelial recurrence after radical nephroureterectomy: preoperative predictors and survival.
abstract: OBJECTIVE
  To identify the preoperative predictors of extraurothelial recurrence (EUR) after radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC).
  
  
  METHODS
  A single-center series of 238 consecutive patients who were treated with RNU for UTUC was evaluated. Recurrence-free probabilities and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Multivariate Cox proportional hazards regression models were used to evaluate the association between various clinicopathological factors and EUR.
  
  
  RESULTS
  The median time to EUR was 17.6 months (range 3-73 months). EUR-free survival rates at 1, 3, 5, and 7 years were 87.8, 75.2, 73.5, and 72.6%, respectively. In multivariate Cox regression analyses, tumor stage (HR 27.4; 95% CI 7.83-95.8; p = 0.0001) and lymphovascular invasion (LVI) (HR 1.53; 95% CI 1.22-3.12; p = 0.01) were independently associated with EUR. In patients with EUR, 5-year CSS estimate was 29.2%. Tumor stage (HR 14.3; 95% CI 4.55-45.2; p < 0.001) and EUR (HR 2.7; 95% CI 1.54-4.73; p = 0.001) were the only independent predictors associated with worse CSS.
  
  
  CONCLUSIONS
  EUR significantly affected the prognosis in patients with UTUC managed by RNU. Patient with EUR had a greater probability of having higher tumor stages, higher tumor grades, and positive LVI. Tumor stage and LVI were independently associated with a worse EUR-free survival.
authors.affiliation: Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Resavska 51, 11000, Belgrade, Serbia.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Dzamic
authors.forename: Bogomir
authors.initials: B
authors.lastname: Milojevic
authors.forename: Boris
authors.initials: B
authors.lastname: Kajmakovic
authors.forename: Isidora
authors.initials: I
authors.lastname: Grozdic Milojevic
authors.forename: Nebojsa
authors.initials: N
authors.lastname: Bojanic
authors.forename: Sandra
authors.initials: S
authors.lastname: Sipetic Grujicic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001808:Blood Vessels / Q000473:pathology; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D009392:Nephrectomy; D015996:Survival Rate; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery
chemical_list: D002945:Cisplatin