title: Patient age was an independent predictor of cancer-specific survival in male patients with upper tract urothelial carcinoma treated by radical nephroureterectomy.
abstract: We hypothesized that there may be a prognostic difference in age between the genders and evaluated the influence of gender-adjusted age on prognosis in upper tract urothelial carcinoma patients.
  
  
  
  A total of 839 patients with upper tract urothelial carcinoma from a retrospective multi-institutional cohort were included. The patients were divided into four groups consisting of males (N = 610) and females (N = 229) according to age ((i) <60 years, (ii) 60-69.9 years, (iii) 70-79.9 years and (iv) ≥80 years), and we evaluated the associations of patient age and gender with clinicopathological features and oncological outcomes following radical nephroureterectomy. The median follow-up duration was 34 months.
  
  
  
  Disease recurrence occurred in 249 patients and 192 patients died of upper tract urothelial carcinoma. The 3-year cancer-specific survival rates were (i) 84.3%, (ii) 80.2%, (iii) 77.1% and (iv) 71.5% in the entire patient population (P = 0.001); (i) 84.5%, (ii) 81.1%, (iii) 76.8% and (iv) 69.7% in males (P = 0.010); and (i) 83.3%, (ii) 76.9%, (iii) 77.7% and (iv) 72.9% in females (P = 0.287), respectively. No significant differences between disease recurrence and age were found in the male or female population. In multivariate analysis, older age was an independent predictor of cancer-specific survival, in addition to advanced pT stage, the presence of lymphovascular invasion and lymph node involvement in males. In contrast, age was not associated with cancer-specific survival in females, while high grade, advanced pT stage, the presence of lymph node involvement and multifocal tumor were independent predictors.
  
  
  
  The results indicate that gender-adjusted age might be a new prognostic factor in upper tract urothelial carcinoma patients.
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo Department of Urology, Kyosai Tachikawa Hospital, Tokyo.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kobayashi
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo eiji-k@kb3.so-net.ne.jp.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.affiliation: Department of Urology, Saitama City Hospital, Saitama Department of Urology, National Hospital Organization, Saitama Hospital, Saitama.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Tanaka
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo Department of Urology, International Medical Center-Comprehensive Cancer Center, Saitama Medical University, Saitama.
authors.forename: Suguru
authors.initials: S
authors.lastname: Shirotake
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo Department of Urology, Ogikubo Hospital, Tokyo.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Miyazaki
authors.affiliation: Department of Urology, Inagi Municipal Hospital, Tokyo Department of Urology, Musashino Yohwakai Hospital, Tokyo.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ide
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo Department of Urology, National Hospital Organization, Tochigi Medical Center, Tochigi.
authors.forename: Jun
authors.initials: J
authors.lastname: Obata
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa.
authors.forename: Katsura
authors.initials: K
authors.lastname: Hoshino
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo Department of Urology, Tokyo Saiseikai Central Hospital, Tokyo.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo Department of Urology, Kawasaki Municipal Hospital, Kanagawa.
authors.forename: Gou
authors.initials: G
authors.lastname: Kaneko
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo Department of Urology, Tokyo Dental College Ichikawa General Hospital, Chiba.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hagiwara
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo Department of Urology, Irumagawa Hospital, Saitama, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Kosaka
authors.affiliation: Department of Urology, International Medical Center-Comprehensive Cancer Center, Saitama Medical University, Saitama.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Oyama
authors.affiliation: Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Nakajima
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo.
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Oya
keywords: age; gender; radical nephroureterectomy; upper urinary tract; urothelial carcinoma