TY - JOUR
T1 - Ureteral location is associated with survival outcomes in upper tract urothelial carcinoma
T2 - A population-based analysis
AU - Veccia, Alessandro
AU - Antonelli, Alessandro
AU - Martini, Alberto
AU - Falagario, Ugo
AU - Carrieri, Giuseppe
AU - Grob, Mayer B.
AU - Guruli, Georgi
AU - Simeone, Claudio
AU - Wiklund, Peter
AU - Porpiglia, Francesco
AU - Autorino, Riccardo
N1 - Publisher Copyright:
© 2020 The Japanese Urological Association
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/11
Y1 - 2020/11
N2 - Objectives: To evaluate the prognostic value of tumor location in patients with upper tract urothelial carcinoma. Methods: Within the Surveillance, Epidemiology and End Results Incidence Database, 6619 upper tract urothelial carcinoma cases were identified, including 3719 confined to the renal pelvis and 2971 to the ureter. Predictors of surgical technique (kidney sparing surgery versus radical nephroureterectomy), as well as 2- and 5-year cancer-specific survival and overall survival were evaluated. Results: Median follow-up time was 29 months (interquartile range 0–126 months) for both groups. Multivariate logistic analysis showed tumor dimension as the only factor associated with radical nephroureterectomy (odds ratio 1.02; P < 0.001). Ureteral 2- and 5-year overall survival were lower (log–rank P = 0.001) compared with renal pelvis. When stratifying tumor location according to dimensions, a ureteral carcinoma >3 cm was associated with the worst 2- and 5-year cancer-specific mortality (Pepe-Mori P < 0.001), and overall survival (log–rank P < 0.001). The 2- and 5-year cancer-specific mortality (Pepe-Mori P < 0.001) and overall survival were the worst for ureteral ≥T3 tumors (log–rank P < 0.001). The 2- and 5-year cancer-specific mortality (Pepe–Mori P < 0.001) and overall survival (log–rank P < 0.001) were the worst for ureteral grade III–IV cancers. Ureteral tumor location (subdistribution hazard ratio 1.18, P < 0.001), tumor dimension ≥3 (subdistribution hazard ratio 1.25, P < 0.001), T staging (T2–4 all P < 0.001), grading (grade III subdistribution hazard ratio 2.20, P = 0.001; grade IV subdistribution hazard ratio 2.39, P < 0.001) were found to be associated with higher cancer mortality. Conclusions: Ureteral tumor location in upper tract urothelial carcinoma seems to be associated with worse oncological outcomes, especially in the case of advanced disease. Although the type of surgical treatment does not seem to impact survival, surgeons should use caution in adopting a kidney-sparing surgery for patients with ureteral upper tract urothelial carcinoma.
AB - Objectives: To evaluate the prognostic value of tumor location in patients with upper tract urothelial carcinoma. Methods: Within the Surveillance, Epidemiology and End Results Incidence Database, 6619 upper tract urothelial carcinoma cases were identified, including 3719 confined to the renal pelvis and 2971 to the ureter. Predictors of surgical technique (kidney sparing surgery versus radical nephroureterectomy), as well as 2- and 5-year cancer-specific survival and overall survival were evaluated. Results: Median follow-up time was 29 months (interquartile range 0–126 months) for both groups. Multivariate logistic analysis showed tumor dimension as the only factor associated with radical nephroureterectomy (odds ratio 1.02; P < 0.001). Ureteral 2- and 5-year overall survival were lower (log–rank P = 0.001) compared with renal pelvis. When stratifying tumor location according to dimensions, a ureteral carcinoma >3 cm was associated with the worst 2- and 5-year cancer-specific mortality (Pepe-Mori P < 0.001), and overall survival (log–rank P < 0.001). The 2- and 5-year cancer-specific mortality (Pepe-Mori P < 0.001) and overall survival were the worst for ureteral ≥T3 tumors (log–rank P < 0.001). The 2- and 5-year cancer-specific mortality (Pepe–Mori P < 0.001) and overall survival (log–rank P < 0.001) were the worst for ureteral grade III–IV cancers. Ureteral tumor location (subdistribution hazard ratio 1.18, P < 0.001), tumor dimension ≥3 (subdistribution hazard ratio 1.25, P < 0.001), T staging (T2–4 all P < 0.001), grading (grade III subdistribution hazard ratio 2.20, P = 0.001; grade IV subdistribution hazard ratio 2.39, P < 0.001) were found to be associated with higher cancer mortality. Conclusions: Ureteral tumor location in upper tract urothelial carcinoma seems to be associated with worse oncological outcomes, especially in the case of advanced disease. Although the type of surgical treatment does not seem to impact survival, surgeons should use caution in adopting a kidney-sparing surgery for patients with ureteral upper tract urothelial carcinoma.
KW - endoscopic
KW - radical nephroureterectomy
KW - renal pelvis
KW - segmental ureterectomy
KW - upper tract carcinoma
KW - ureter
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U2 - 10.1111/iju.14336
DO - 10.1111/iju.14336
M3 - Article
C2 - 32776386
AN - SCOPUS:85089067198
VL - 27
SP - 966
EP - 972
JO - International Journal of Urology
JF - International Journal of Urology
SN - 0919-8172
IS - 11
ER -