title: Prognostic factors of recurrent disease in upper urinary tract urothelial cancer after radical nephroureterectomy: Subanalysis of the multi-institutional national database of the Japanese Urological Association.
abstract: OBJECTIVE
  To explore predictive factors of disease recurrence after radical nephroureterectomy in patients with upper urinary tract urothelial cancer.
  
  
  METHODS
  A multi-institutional national database promoted by the Japanese Urological Association including 293 institutions and 1172 patients was used for the present study. Patient with non-metastatic upper urinary tract urothelial cancer who underwent primary radical nephroureterectomy with curative intent were analyzed. Univariate analysis using the Kaplan-Meier method and multivariate Cox regression models with stepwise selection was used to evaluate time to recurrence after surgery.
  
  
  RESULTS
  The median duration of follow up was 55.8 months, and disease recurred in 325 (27.7%) patients at a median of 11.4 months after radical nephroureterectomy. According to a Cox proportional hazards model, the Union International Contre le Cancer 2002 pathological stage of the primary tumor, lymph node status, presence of lymphatic and/or vascular invasion, infiltrative growth pattern, and age were independent predictors (P < 0.05) of recurrence-free survival.
  
  
  CONCLUSIONS
  Despite several limitations, our analysis suggests that pathological tumor stage, lymph node status, lymphovascular invasion, infiltrative growth pattern and age represent important prognostic variables after radical nephroureterectomy in Japanese patients with upper urinary tract urothelial cancer. This information could be potentially used to select patients for adjuvant systemic therapy.
authors.affiliation: Working Group of the Renal Pelvic and Ureteral Cancer, Cancer Registration Committee of the Japanese Urological Association.|National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Hara
authors.affiliation: Working Group of the Renal Pelvic and Ureteral Cancer, Cancer Registration Committee of the Japanese Urological Association.|National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fujimoto
authors.affiliation: Working Group of the Renal Pelvic and Ureteral Cancer, Cancer Registration Committee of the Japanese Urological Association.|Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, Japan.
authors.forename: Mizuaki
authors.initials: M
authors.lastname: Sakura
authors.affiliation: Working Group of the Renal Pelvic and Ureteral Cancer, Cancer Registration Committee of the Japanese Urological Association.|Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Inokuchi
authors.affiliation: Working Group of the Renal Pelvic and Ureteral Cancer, Cancer Registration Committee of the Japanese Urological Association.|Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishiyama
authors.affiliation: Working Group of the Renal Pelvic and Ureteral Cancer, Cancer Registration Committee of the Japanese Urological Association.|Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Miyazaki
authors.affiliation: Working Group of the Renal Pelvic and Ureteral Cancer, Cancer Registration Committee of the Japanese Urological Association.|Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Chikara
authors.initials: C
authors.lastname: Ohyama
authors.affiliation: Working Group of the Renal Pelvic and Ureteral Cancer, Cancer Registration Committee of the Japanese Urological Association.|Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Koie
authors.affiliation: Working Group of the Renal Pelvic and Ureteral Cancer, Cancer Registration Committee of the Japanese Urological Association.|Department of Urology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.affiliation: Working Group of the Renal Pelvic and Ureteral Cancer, Cancer Registration Committee of the Japanese Urological Association.|Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Hinotsu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D009392:Nephrectomy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014519:Ureterostomy; D014571:Urologic Neoplasms / Q000601:surgery*; D019459:Urothelium / Q000473:pathology*
keywords: disease recurrence; disease-free survival; nephroureterectomy; prognostic factors; renal pelvic cancer; ureteral cancer