title: Impact of multimodal treatment on prognosis for patients with metastatic upper urinary tract urothelial cancer: Subanalysis of the multi-institutional nationwide case series study of the Japanese Urological Association.
abstract: OBJECTIVE
  To describe the nature of metastatic upper urinary tract urothelial cancer and determine the prognostic predictors or treatment modality associated with all-cause mortality.
  
  
  METHODS
  Within the nationwide case series study of the Japanese Urological Association, consisting of 1509 patients with urinary tract urothelial cancer diagnosed in 2005, we identified 102 patients with metastatic urinary tract urothelial cancer. Univariate and multivariate survival analyses identified prognostic outcome variables.
  
  
  RESULTS
  Predominant sites of distant metastasis at diagnosis were the lungs (54.9%), distant lymph nodes (37.3%), bone (32.4%) and liver (19.6%). Of 102 patients, 70 patients (68.6%) died during the median follow-up period of 6 months, and the 2-year overall survival rate was estimated at 22%. The median survival time to all-cause mortality was 8.5 months (95% confidence interval 6.4-10.7 months). On multivariate analysis, independent predictive factors for all-cause mortality were age (hazard ratio 2.36, P = 0.015) and liver metastasis (hazard ratio 2.35, P = 0.037). Patients who received multimodal treatment including chemotherapy and surgery showed significantly better prognosis (median survival time 25.8 months) compared with patients treated with chemotherapy alone (median survival time 7.3 months) or best supportive care (median survival time 4.3 months).
  
  
  CONCLUSIONS
  Age at diagnosis and the presence of liver metastasis seem to have an impact on survival of metastatic urinary tract urothelial cancer patients. Multimodal treatment including systemic chemotherapy and surgery might result in better prognosis in some of these patients.
authors.affiliation: Working Group of the Renal Pelvic and Ureteral Cancer, Cancer Registration Committee of the Japanese Urological Association, Fukuoka, Japan.|Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Inokuchi
authors.affiliation: Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.|Department of Urology, Harasanshin Hospital, Fukuoka, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Naito
authors.affiliation: Working Group of the Renal Pelvic and Ureteral Cancer, Cancer Registration Committee of the Japanese Urological Association, Fukuoka, Japan.|Urology Division, 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, Fukuoka, Japan.|Urology Division, 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, Fukuoka, Japan.|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, Fukuoka, Japan.|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, Fukuoka, Japan.|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, Fukuoka, Japan.|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, Fukuoka, Japan.|Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Hinotsu
authors.affiliation: Working Group of the Renal Pelvic and Ureteral Cancer, Cancer Registration Committee of the Japanese Urological Association, Fukuoka, Japan.|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, Fukuoka, Japan.|Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Chikara
authors.initials: C
authors.lastname: Ohyama
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D019459:Urothelium / Q000473:pathology*
chemical_list: D000970:Antineoplastic Agents
keywords: Japanese; multimodal treatment; prognosis; survival; upper urinary tract urothelial cancer