Tomohiko Hara1,2, Hiroyuki Fujimoto1,2, Mizuaki Sakura1,3, Junichi Inokuchi1,4, Hiroyuki Nishiyama1,5, Jun Miyazaki1,5, Chikara Ohyama1,6, Takuya Koie1,6, Eiji Kikuchi1,7, Shiro Hinotsu1,8. 1. Working Group of the Renal Pelvic and Ureteral Cancer, Cancer Registration Committee of the Japanese Urological Association. 2. National Cancer Center Hospital, Tokyo, Japan. 3. Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, Japan. 4. Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 5. Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. 6. Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. 7. Department of Urology, Keio University School of Medicine, Tokyo, Japan. 8. Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan.
Abstract
OBJECTIVES: To explore predictive factors of disease recurrence after radical nephroureterectomy in patients with upper urinary tract urothelial cancer. METHODS: A multi-institutional national database promoted by the Japanese Urological Association including 293 institutions and 1172 patients was used for the present study. Patient with non-metastatic upper urinary tract urothelial cancer who underwent primary radical nephroureterectomy with curative intent were analyzed. Univariate analysis using the Kaplan-Meier method and multivariate Cox regression models with stepwise selection was used to evaluate time to recurrence after surgery. RESULTS: The median duration of follow up was 55.8 months, and disease recurred in 325 (27.7%) patients at a median of 11.4 months after radical nephroureterectomy. According to a Cox proportional hazards model, the Union International Contre le Cancer 2002 pathological stage of the primary tumor, lymph node status, presence of lymphatic and/or vascular invasion, infiltrative growth pattern, and age were independent predictors (P < 0.05) of recurrence-free survival. CONCLUSIONS: Despite several limitations, our analysis suggests that pathological tumor stage, lymph node status, lymphovascular invasion, infiltrative growth pattern and age represent important prognostic variables after radical nephroureterectomy in Japanese patients with upper urinary tract urothelial cancer. This information could be potentially used to select patients for adjuvant systemic therapy.
OBJECTIVES: To explore predictive factors of disease recurrence after radical nephroureterectomy in patients with upper urinary tract urothelial cancer. METHODS: A multi-institutional national database promoted by the Japanese Urological Association including 293 institutions and 1172 patients was used for the present study. Patient with non-metastatic upper urinary tract urothelial cancer who underwent primary radical nephroureterectomy with curative intent were analyzed. Univariate analysis using the Kaplan-Meier method and multivariate Cox regression models with stepwise selection was used to evaluate time to recurrence after surgery. RESULTS: The median duration of follow up was 55.8 months, and disease recurred in 325 (27.7%) patients at a median of 11.4 months after radical nephroureterectomy. According to a Cox proportional hazards model, the Union International Contre le Cancer 2002 pathological stage of the primary tumor, lymph node status, presence of lymphatic and/or vascular invasion, infiltrative growth pattern, and age were independent predictors (P < 0.05) of recurrence-free survival. CONCLUSIONS: Despite several limitations, our analysis suggests that pathological tumor stage, lymph node status, lymphovascular invasion, infiltrative growth pattern and age represent important prognostic variables after radical nephroureterectomy in Japanese patients with upper urinary tract urothelial cancer. This information could be potentially used to select patients for adjuvant systemic therapy.