Impact of tumor location on local recurrence after nephroureterectomy for upper tract urothelial carcinoma: Implications for adjuvant radiotherapy.

Abstract

390 Background: To date, risk factors for local recurrence after complete removal of upper tract urothelial carcinoma (UTUC) have not been clearly identified. We evaluated the impact of tumor location on local recurrence in UTUC patients underwent radical nephroureterectomy. Methods: Among UTUC patients who underwent radical nephroureterectomy between 1998 and 2012, 192 (54.4%) patients with renal pelvic tumor and 161 (45.6%) patients with ureter tumor were included. Local recurrence was divided into regional lymph node recurrence (LNR) and surgical bed recurrence (SBR). The significance of tumor location and other variables on local recurrence were evaluated. Results: Lymphovascular invasion (p = 0.003), carcinoma in situ (p = 0.006) and high grade tumor (p < 0.001) were more common in ureter tumor. During median follow-up period of 73 months, local recurrence was occurred in 33 (9.3%) patients. Among subtype of local recurrence, SBR (8.1 vs. 2.1%, p = 0.011) were more common in patients with ureter tumor compared to renal pelvic tumor although the probability of regional LNR was not significantly different according to tumor location (7.5% vs. 3.1%, p = 0.088). 5-year local recurrence-free survival (80.5% vs. 94.2%, p = 0.002), LNR-free survival (89.8 vs. 96.5%, p = 0.046) and SBR-free survival (88.3% vs. 97.6%, p = 0.005) were inferior in ureter tumor compared to renal pelvic tumor. Ureter tumor (HR; 2.552, p = 0.017), high grade tumor (HR; 3.064, p = 0.016) and advanced tumor stage (≥T3) (HR; 3.236, p = 0.002) were associated with local recurrence. Ureter tumor (HR; 4.704, p = 0.002) and advanced tumor stage (HR; 4.840, p = 0.006) were risk factors for SBR. However, tumor location was not associated with LNR although lymphovascular invasion (HR; 5.451, p < 0.001) and high grade tumor (HR; 4.191, p = 0.012) were related with LNR. Conclusions: Ureter located tumor was associated with local recurrence which comes from the SBR. Adjuvant radiotherapy or surgical technique for reducing the risk of SBR should be considered in patients with ureter tumor.