Guillaume Ploussard1, Evanguelos Xylinas2, Yair Lotan3, Giacomo Novara4, Vitaly Margulis3, Morgan Rouprêt5, Kazumasa Matsumoto6, Pierre I Karakiewicz7, Francesco Montorsi8, Mezut Remzi9, Christian Seitz9, Douglas S Scherr10, Anil Kapoor11, Adrian S Fairey12, Ricardo Rendon13, Jonathan Izawa14, Peter C Black15, Louis Lacombe16, Shahrokh F Shariat17, Wassim Kassouf18. 1. Department of Surgery, McGill University, Montreal, Quebec, Canada; Department of Urology, Saint-Louis Hospital, APHP, Paris 7 University, Paris, France. 2. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France. 3. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 4. Department of Surgery, Oncology, and Gastroenterology-Urology Clinic, University of Padua, Padua, Italy. 5. Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France. 6. Department of Urology, Kitasato University School of Medicine, Minami-ku, Sagamihara, Kanagawa, Japan. 7. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada. 8. Department of Urology, Vita-Salute San Raffaele University, Milan, Italy. 9. Department of Urology, Medical University of Vienna, Vienna, Austria. 10. Department of Urology, Weill Cornell Medical College, New York, NY, USA. 11. Department of Urology, McMaster University, St. Joseph Hospital, Hamilton, Ontario, Canada. 12. Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. 13. Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. 14. Department of Surgery, Western University, London, Ontario, Canada. 15. Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada. 16. Department of Surgery, Laval University, Quebec, Quebec, Canada. 17. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Medical University of Vienna, Vienna, Austria. 18. Department of Surgery, McGill University, Montreal, Quebec, Canada. Electronic address: wassim.kassouf@muhc.mcgill.ca.
Abstract
BACKGROUND: Conditional survival (CS) provides better estimates of the survival probability at each follow-up time, and its usefulness has been proven in several solid malignancies. OBJECTIVE: To assess the changes in 5-yr CS rates after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) and to determine how well-established prognostic factors evolve over time. DESIGN, SETTING, AND PARTICIPANTS: We analysed data from 3544 patients treated with RNU at 15 international academic centres between 1989 and 2012. INTERVENTION: RNU. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS: Conditional intravesical recurrence-free (IVRFS), cancer-specific survival (CSS), and overall survival (OS) estimates were calculated using the Kaplan-Meier method. A multivariable Cox regression model was used to calculate proportional hazard ratios for the prediction of mortality. RESULTS AND LIMITATIONS: The 5-yr bladder cancer recurrence-free survival, CSS, and OS rates were 54.9%, 72.2%, and 62.6%, respectively. Given a 1-, 2-, 3-, and 4-yr survivorship, the 5-yr conditional OS rates improved to 65.2%, 69.3%, 71.5%, and 73.0%, respectively. The 5-yr CS improvement was primarily noted among surviving patients with advanced-stage disease. The impact of pathologic parameters on CS estimates decreased over time for both CSS and OS, whereas the impact of age and gender increased with survivorship. No survival benefit was noted regarding the adjuvant chemotherapy status. Findings were confirmed upon multivariable analyses. Tumour location, the presence of carcinoma in situ, and the type of bladder cuff excision were continuously predictive for IVRFS whatever the survivorship. A limitation is the retrospective design. CONCLUSIONS: CS analysis demonstrates that the patient risk profile evolves during the post-RNU follow-up. The probability of survival markedly increases over time in patients having high-stage disease. The impact of prognostic pathologic features decreases over time and can disappear for long-term CS. PATIENT SUMMARY: In this study, we found that the risk of intravesical recurrence, cancer-specific survival, and overall mortality evolves over the follow-up after surgery. Taking into account the survivorship provides better estimates of the survival probability at each follow-up time.
BACKGROUND: Conditional survival (CS) provides better estimates of the survival probability at each follow-up time, and its usefulness has been proven in several solid malignancies. OBJECTIVE: To assess the changes in 5-yr CS rates after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) and to determine how well-established prognostic factors evolve over time. DESIGN, SETTING, AND PARTICIPANTS: We analysed data from 3544 patients treated with RNU at 15 international academic centres between 1989 and 2012. INTERVENTION: RNU. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS: Conditional intravesical recurrence-free (IVRFS), cancer-specific survival (CSS), and overall survival (OS) estimates were calculated using the Kaplan-Meier method. A multivariable Cox regression model was used to calculate proportional hazard ratios for the prediction of mortality. RESULTS AND LIMITATIONS: The 5-yr bladder cancer recurrence-free survival, CSS, and OS rates were 54.9%, 72.2%, and 62.6%, respectively. Given a 1-, 2-, 3-, and 4-yr survivorship, the 5-yr conditional OS rates improved to 65.2%, 69.3%, 71.5%, and 73.0%, respectively. The 5-yr CS improvement was primarily noted among surviving patients with advanced-stage disease. The impact of pathologic parameters on CS estimates decreased over time for both CSS and OS, whereas the impact of age and gender increased with survivorship. No survival benefit was noted regarding the adjuvant chemotherapy status. Findings were confirmed upon multivariable analyses. Tumour location, the presence of carcinoma in situ, and the type of bladder cuff excision were continuously predictive for IVRFS whatever the survivorship. A limitation is the retrospective design. CONCLUSIONS: CS analysis demonstrates that the patient risk profile evolves during the post-RNU follow-up. The probability of survival markedly increases over time in patients having high-stage disease. The impact of prognostic pathologic features decreases over time and can disappear for long-term CS. PATIENT SUMMARY: In this study, we found that the risk of intravesical recurrence, cancer-specific survival, and overall mortality evolves over the follow-up after surgery. Taking into account the survivorship provides better estimates of the survival probability at each follow-up time.
Authors: Francesco Alessandro Mistretta; Carlotta Palumbo; Sophie Knipper; Elio Mazzone; Angela Pecoraro; Zhe Tian; Gennaro Musi; Paul Perrotte; Emanuele Montanari; Shahrokh F Shariat; Fred Saad; Alberto Briganti; Ottavio de Cobelli; Pierre I Karakiewicz Journal: World J Urol Date: 2019-07-11 Impact factor: 4.226
Authors: Yuhree Kim; Georgios A Margonis; Jason D Prescott; Thuy B Tran; Lauren M Postlewait; Shishir K Maithel; Tracy S Wang; Jason A Glenn; Ioannis Hatzaras; Rivfka Shenoy; John E Phay; Kara Keplinger; Ryan C Fields; Linda X Jin; Sharon M Weber; Ahmed Salem; Jason K Sicklick; Shady Gad; Adam C Yopp; John C Mansour; Quan-Yang Duh; Natalie Seiser; Carmen C Solorzano; Colleen M Kiernan; Konstantinos I Votanopoulos; Edward A Levine; George A Poultsides; Timothy M Pawlik Journal: Ann Surg Date: 2017-01 Impact factor: 12.969
Authors: Aurélie Mbeutcha; Ilaria Lucca; Vitaly Margulis; Jose A Karam; Christopher G Wood; Michela de Martino; Romain Mathieu; Andrea Haitel; Evanguelos Xylinas; Luis Kluth; Morgan Rouprêt; Pierre I Karakiewicz; Alberto Briganti; Michael Rink; Malte Rieken; Alon Z Weizer; Jay D Raman; Nathalie Rioux-Leclecq; Christian Bolenz; Karim Bensalah; Yair Lotan; Christian Seitz; Mesut Remzi; Shahrokh F Shariat; Tobias Klatte Journal: World J Urol Date: 2015-12-11 Impact factor: 4.226