The effect of tumor location on oncologic outcomes in patients with upper urinary tract urothelial carcinoma stratified by pathologic stage.
OBJECTIVE
The aim of this study was to investigate the effect of tumor location on oncologic outcomes in patients with upper urinary tract urothelial carcinoma (UTUC) stratified according to pathologic stage.


METHODS
Between January 1996 and March 2009, 503 patients with UTUC were enrolled who had undergone radical nephroureterectomies and had no nodal or distal metastases. Preoperative chemotherapy or radiation therapy was not administered to any study patient. Clinicopathologic patient characteristics were obtained and used to analyze recurrence-free survival (RFS), cancer-specific survival, and overall survival with the Cox proportional hazards model.


RESULTS
During the median follow-up of 52 months, patients with pathologic tumor (pT) stage 3 ureteral tumors had a shorter duration of RFS compared with those with pT3 renal pelvis tumors (5-y RFS: 50% and 71%, P = 0.047). There was no prognostic relevance to the tumor location in pTa/Tis/T1 and pT2 diseases. RFS and cancer-specific survival were significantly shorter in duration in pT3 ureteral disease compared with pT2 diseases (P<0.001 and P = 0.028). No differences were found in oncologic outcomes between pT3 renal pelvic and pT2 diseases. The presence of pT3 ureteral tumors actually increased the risks of disease recurrence (hazard ratio [HR] = 7.82, P<0.001), cancer-specific death (HR = 5.08, P<0.001), and overall mortality (HR = 3.25, P = 0.031).


CONCLUSIONS
Patients with UTUC and pT3 ureteral tumors had an increased risk of disease recurrence and cancer-specific death. These results underscore the need for close follow-up and the consideration of adjuvant chemotherapy for patients with pT3 ureteral cancer.
Department of Urology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.
Yi-Sheng
YS
Tai
Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan. Electronic address: mufasachen@gmail.com.
Chung-Hsin
CH
Chen
Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
Chao-Yuan
CY
Huang
Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
Huai-Chin
HC
Tai
Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
Sho-Mon
SM
Wang
Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
Yeong-Shiau
YS
Pu
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009392:Nephrectomy; D010386:Pelvic Neoplasms / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D015996:Survival Rate; D014516:Ureteral Neoplasms / Q000473:pathology* / Q000601:surgery; D014571:Urologic Neoplasms / Q000473:pathology* / Q000601:surgery
Tumor stage; Upper urinary tract urothelial carcinoma; Ureteral tumor; disease recurrence