Abstract
BackgroundWe aimed to evaluate the impact of tumor location on cancer outcomes in patients with pT3N0M0 upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU) with bladder cuff excision.Materials and MethodsWe retrospectively reviewed 302 patients with pT3N0M0 UTUC who underwent RNU with bladder cuff excision at our institution between 2005 and 2019, including 191 renal pelvis tumors and 111 ureteral tumors. Clinicopathologic characteristics were compared between renal pelvis and ureter urothelial carcinomas. Multivariate Cox proportional hazard regression was used to assess the association between outcomes and clinical factors. Outcomes of interest included intravesical recurrence-free survival (IVRFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS), which were measured using the Kaplan–Meier curve with a log-rank test.ResultsA total of 302 patients underwent RNU with bladder cuff excision. During the median follow-up of 42.7 months, 70 (23.2%), 95 (31.5%), and 99 (32.8%) patients experienced intravesical recurrence, local recurrence, and distant metastasis, respectively. Seventy (23.2%) patients died from UTUC. Multivariate Cox regression analysis showed that tumor location was an independent predictor of local recurrence (HR = 2.05, p = 0.001), with borderline independent significance in intravesical recurrence (HR = 1.54, p = 0.074) and distant metastasis (HR = 1.45, p = 0.08). Kaplan–Meier analysis showed that ureter tumors had a worse 5-year local recurrence (log-rank p < 0.001) and borderline worse 5-year intravesical recurrence (log-rank p = 0.055) and 5-year distant metastasis (log-rank p = 0.073).ConclusionUreter tumors seem to be associated with worse oncological outcomes, especially with local recurrence in UTUC. Further large and long-term studies are warranted for investigating biological differences based on tumor location.
Highlights
Urothelial carcinoma (UC), the fourth most common malignancy worldwide, can be located in the upper or lower urinary tract
In our study, we aimed to investigate the prognostic impact of tumor location in patients with pT3N0M0 urinary tract urothelial carcinoma (UTUC) who may respond to adjuvant therapy after radical nephroureterectomy (RNU)
Renal pelvic tumors were more likely to be associated with papillary architecture than ureteral tumors (71.7% and 45.9%, respectively; p < 0.001)
Summary
Urothelial carcinoma (UC), the fourth most common malignancy worldwide, can be located in the upper (pyelocaliceal cavity and ureter) or lower (bladder and urethra) urinary tract. Upper urinary tract urothelial carcinoma (UTUC) is uncommon and accounts for only 5% of all urothelial tumors [1]. The estimated annual incidence of UTUC is 2/100000 in Western countries. Most cases occur in the renal pelvis and are approximately twice as common as ureteral tumors. Radical nephroureterectomy (RNU) with bladder cuff excision has been regarded as the standard treatment for patients with UTUC. Segmental resection and endoscopic management can be considered in selected patients based on tumor location, tumor size, and histological characteristics [2]. We aimed to evaluate the impact of tumor location on cancer outcomes in patients with pT3N0M0 upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU) with bladder cuff excision
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