Clinical Outcomes in Patients with Panurothelial Carcinoma Treated with Radical Nephroureterectomy Following Cystectomy for Metachronous Recurrence.
We report pathological, functional and oncologic outcomes in patients treated with radical nephroureterectomy following radical cystectomy.



We identified patients who underwent radical cystectomy and then radical nephroureterectomy for metachronous urothelial recurrence at our institution between January 1995 and December 2014. Univariable Cox regression was used to assess the association between overall survival and age, grade, stage, lymph node metastasis and radiographic findings.



Of the 3,173 patients treated with radical cystectomy 64 underwent subsequent radical nephroureterectomy for metachronous urothelial recurrence. Median age at radical cystectomy was 66 years (IQR 61-74). In the 64 patients who underwent radical nephroureterectomy median time from radical cystectomy to radical nephroureterectomy was 2.7 years (IQR 1.4-4.6). Among 37 patients who underwent ureteroscopy prior to radical nephroureterectomy 29 (78%) had a positive biopsy. Radical nephroureterectomy pathology findings revealed locally advanced disease (pT3/pT4) in 39% of cases and positive node status in 11% compared with locally advanced disease in 17% and positive node status in 6% on radical cystectomy pathology findings. The post-radical nephroureterectomy estimated glomerular filtration rate was less than 60 and less than 30 ml/minute/1.73 m2in 96% and 40% of patients, respectively. Median overall survival after radical nephroureterectomy was 3.1 years (95% CI 2.4-4.3). Only lymph node involvement at radical nephroureterectomy was significantly associated with worse overall mortality (HR 2.73, 95% CI 1.04-7.15, p = 0.041).



The prognosis is poor in patients with panurothelial carcinoma treated with nephroureterectomy following cystectomy with locally advanced disease in a large proportion. Renal function after these procedures diminished and almost all patients were ineligible for cisplatin based chemotherapy.
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology-Biostatistics (MA), Memorial Sloan Kettering Cancer Center, New York, New York.
Qiang
Q
Li
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology-Biostatistics (MA), Memorial Sloan Kettering Cancer Center, New York, New York.
Melissa
M
Assel
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology-Biostatistics (MA), Memorial Sloan Kettering Cancer Center, New York, New York.
Nicole
N
Benfante
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology-Biostatistics (MA), Memorial Sloan Kettering Cancer Center, New York, New York.
Eugene
E
Pietzak
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology-Biostatistics (MA), Memorial Sloan Kettering Cancer Center, New York, New York.
Aditya
A
Bagrodia
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology-Biostatistics (MA), Memorial Sloan Kettering Cancer Center, New York, New York.
Eugene
E
Cha
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology-Biostatistics (MA), Memorial Sloan Kettering Cancer Center, New York, New York.
Guido
G
Dalbagni
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Epidemiology-Biostatistics (MA), Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: colemanj@mskcc.org.
Jonathan
J
Coleman
D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000074682:Nephroureterectomy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019459:Urothelium
cystectomy; nephrectomy; treatment outcome; urinary bladder neoplasms; urothelium