Yuma Waseda1, Kazutaka Saito2, Junichiro Ishioka1, Yoh Matsuoka1, Noboru Numao1, Yasuhisa Fujii1, Yasuyuki Sakai3, Fumitaka Koga4, Tetsuo Okuno5, Chizuru Arisawa6, Shigeyoshi Kamata7, Katsuji Nagahama8, Hitoshi Masuda9, Junji Yonese9, Yukio Kageyama10, Akira Noro11, Toshihiko Tsujii12, Shinji Morimoto13, Shuichi Gotoh14, Kazunori Kihara1. 1. Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan. 2. Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: kz-saito.uro@tmd.ac.jp. 3. Department of Urology, National Cancer Center Hospital East, Chiba, Japan. 4. Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. 5. Department of Urology, Toride Medical Center, Ibaraki, Japan. 6. Department of Urology, Tobu Chiiki Hospital, Tokyo, Japan. 7. Department of Urology, Soka Municipal Hospital, Soka, Japan. 8. Department of Urology, National Center for Global Health and Medicine, Konodai Hospital, Chiba, Japan. 9. Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. 10. Department of Urology, Saitama Cancer Center, Saitama, Japan. 11. Department of Urology, Saitama Red Cross Hospital, Saitama, Japan. 12. Department of Urology, Tokyo Metropolitan Otsuka Hospital, Tokyo, Japan. 13. Department of Urology, Tsuchiura Kyodo Hospital, Ibaraki, Japan. 14. Department of Urology, Hamamatsu Medical Center, Shizuoka, Japan.
Abstract
BACKGROUND: The prognostic significance of tumor location for patients with upper urinary tract urothelial carcinoma (UUT-UC) has been disputed. Several papers have reported that ureteral cancer is associated with worse prognosis. OBJECTIVE: To investigate the prognostic significance of the presence of ureteral tumors in UUT-UC patients who underwent radical nephroureterectomy (RNU). DESIGN, SETTING, AND PARTICIPANTS: In this multicenter retrospective study, 1068 eligible patients (median follow-up: 40 mo [interquartile range: 17-77 mo]) were divided into three groups based on tumor location: renal pelvic, ureteral, and both-regional (having both renal pelvic and ureteral tumors). The ureteral and both-regional groups were subsequently integrated into the ureteral involvement group to evaluate its prognostic impact. INTERVENTION: All patients underwent RNU. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The prognostic impact of tumor location on survival was analyzed. RESULTS AND LIMITATIONS: The renal pelvic, ureteral, and both-regional groups consisted of 507 (47.5%), 430 (40.3%), and 131 (12.3%) patients, respectively. The ureteral and both-regional groups had a higher rate of lymphovascular invasion and lymph node metastasis compared with the renal pelvic group. The renal pelvic and both-regional tumors presented more frequently with locally advanced stages (pT3/T4) compared with the ureteral tumors. The 5-yr cancer-specific survival (CSS) and progression-free survival (PFS) rates of patients in the ureteral (70.5% and 66.7%, respectively) and both-regional groups (64.8% and 57.8%, respectively) were significantly worse than those in the renal pelvic group (81.9% and 78.1%, respectively). In a multivariate analysis, the presence of ureteral involvement was a significant prognostic factor for CSS (hazard ratio [HR]: 1.50; p=0.006) and PFS (HR: 1.35; p=0.023). This study is inherently limited by the biases associated with its retrospective and multicenter design. CONCLUSIONS: The presence of ureteral involvement had a significant impact on the survival of surgically treated UUT-UC patients associated with a poor prognosis. PATIENT SUMMARY: We demonstrated that the ureteral involvement was associated with poor survival compared with patients with renal pelvic tumor only in upper urinary tract urothelial patients treated by nephroureterectomy.
BACKGROUND: The prognostic significance of tumor location for patients with upper urinary tract urothelial carcinoma (UUT-UC) has been disputed. Several papers have reported that ureteral cancer is associated with worse prognosis. OBJECTIVE: To investigate the prognostic significance of the presence of ureteral tumors in UUT-UC patients who underwent radical nephroureterectomy (RNU). DESIGN, SETTING, AND PARTICIPANTS: In this multicenter retrospective study, 1068 eligible patients (median follow-up: 40 mo [interquartile range: 17-77 mo]) were divided into three groups based on tumor location: renal pelvic, ureteral, and both-regional (having both renal pelvic and ureteral tumors). The ureteral and both-regional groups were subsequently integrated into the ureteral involvement group to evaluate its prognostic impact. INTERVENTION: All patients underwent RNU. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The prognostic impact of tumor location on survival was analyzed. RESULTS AND LIMITATIONS: The renal pelvic, ureteral, and both-regional groups consisted of 507 (47.5%), 430 (40.3%), and 131 (12.3%) patients, respectively. The ureteral and both-regional groups had a higher rate of lymphovascular invasion and lymph node metastasis compared with the renal pelvic group. The renal pelvic and both-regional tumors presented more frequently with locally advanced stages (pT3/T4) compared with the ureteral tumors. The 5-yr cancer-specific survival (CSS) and progression-free survival (PFS) rates of patients in the ureteral (70.5% and 66.7%, respectively) and both-regional groups (64.8% and 57.8%, respectively) were significantly worse than those in the renal pelvic group (81.9% and 78.1%, respectively). In a multivariate analysis, the presence of ureteral involvement was a significant prognostic factor for CSS (hazard ratio [HR]: 1.50; p=0.006) and PFS (HR: 1.35; p=0.023). This study is inherently limited by the biases associated with its retrospective and multicenter design. CONCLUSIONS: The presence of ureteral involvement had a significant impact on the survival of surgically treated UUT-UC patients associated with a poor prognosis. PATIENT SUMMARY: We demonstrated that the ureteral involvement was associated with poor survival compared with patients with renal pelvic tumor only in upper urinary tract urothelial patients treated by nephroureterectomy.
Authors: Tzu Shuang Chen; Yen Ta Chen; Hung Jen Wang; Po Hui Chiang; Wen Chou Yang; Wei Ching Lee; Yao Chi Chuang; Yuan Tso Cheng; Chih Hsiung Kang; Wei Chia Lee; Chien Hsu Chen; Yuan Chi Shen; Yi Yang Liu; Hui Ying Liu; Yin Lun Chang; Yu Li Su; Chun Chieh Huang; Hao Lun Luo Journal: Front Oncol Date: 2022-03-15 Impact factor: 6.244
Authors: Wojciech Krajewski; Łukasz Nowak; Bartosz Małkiewicz; Joanna Chorbińska; Paweł Kiełb; Adrian Poterek; Bartłomiej Sporniak; Michał Sut; Marco Moschini; Chiara Lonati; Roberto Carando; Jeremy Yuen-Chun Teoh; Keiichiro Mori; Krzysztof Kaliszewski; Tomasz Szydełko Journal: J Pers Med Date: 2021-12-14