title: Changes in oncological outcomes after radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma treated in the last two decades: a retrospective analysis based on a multicenter collaborative study.
abstract: OBJECTIVE
  We investigated chronological changes in the outcomes of patients with upper urinary tract urothelial carcinoma treated in the past two decades, during which there was an important change in treatment paradigm.
  
  
  METHODS
  A retrospective review was conducted of 1180 urinary tract urothelial carcinoma patients who underwent radical nephroureterectomy in multicenter collaborative institutions between 1996 and 2015. The patients were divided into four groups according to the year when radical nephroureterectomy was performed, as follows: 1996-2000 (period 1; P1), 2001-05 (P2), 2006-10 (P3) and 2011-15 (P4). Variables including tumor grade, T and N categories, administration of perioperative chemotherapy and treatment outcomes were compared among the four groups.
  
  
  RESULTS
  There were 146 (12%), 312 (27%), 459 (39%) and 263 (22%) patients in the P1, P2, P3 and P4 groups, respectively. The proportion of patients harboring pT2/3 and Grade 3 tumors increased gradually from 42% (P1) to 58% (P4) and from 49% (P1) to 65% (P4), respectively. The 5-year disease-free survival rates were 74%, 74%, 73% and 75%, and the 5-year overall survival rates were 74%, 65%, 67% and 72% for the P1, P2, P3, and P4 groups, respectively. Multivariate analysis with adjustment for possible confounding factors revealed no significant differences in disease-specific survival, overall survival or intravesical recurrence-free survival among the four groups.
  
  
  CONCLUSIONS
  Despite advances in diagnostic instruments, surgery and systemic chemotherapy, the clinical outcome of urinary tract urothelial carcinoma after radical surgery has not significantly improved over the last two decades, and further research is therefore required.
authors: Department of Urology, Nara Medical University, Kashihara, Nara.
authors: Makito
authors: M
authors: Miyake
authors: Department of Urology, Nara Medical University, Kashihara, Nara.
authors: Yoshihiro
authors: Y
authors: Tatsumi
authors: Department of Urology, Nara Medical University, Kashihara, Nara kiyokun@naramed-u.ac.jp.
authors: Kiyohide
authors: K
authors: Fujimoto
authors: Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
authors: Kazuhiro
authors: K
authors: Nagao
authors: Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
authors: Shigeru
authors: S
authors: Sakano
authors: Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
authors: Hideyasu
authors: H
authors: Matsuyama
authors: Department of Urology, Osaka Medical College, Takatsuki, Osaka.
authors: Teruo
authors: T
authors: Inamoto
authors: Department of Urology, Osaka Medical College, Takatsuki, Osaka.
authors: Haruhito
authors: H
authors: Azuma
authors: Department of Urology, Shimane University School of Medicine, Izumo, Shimane, Japan.
authors: Hiroaki
authors: H
authors: Yasumoto
authors: Department of Urology, Shimane University School of Medicine, Izumo, Shimane, Japan.
authors: Hiroaki
authors: H
authors: Shiina
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009392:Nephrectomy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000401:mortality / Q000601:surgery*
keywords: chronological change; disease-specific survival; intravesical recurrence; overall survival; upper urinary tract carcinoma; urothelial carcinoma