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Extraurothelial recurrence after radical nephroureterectomy: preoperative predictors and survival

  • Urology - Original Paper
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Abstract

Objective

To identify the preoperative predictors of extraurothelial recurrence (EUR) after radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC).

Methods

A single-center series of 238 consecutive patients who were treated with RNU for UTUC was evaluated. Recurrence-free probabilities and cancer-specific survival (CSS) were estimated using the Kaplan–Meier method. Multivariate Cox proportional hazards regression models were used to evaluate the association between various clinicopathological factors and EUR.

Results

The median time to EUR was 17.6 months (range 3–73 months). EUR-free survival rates at 1, 3, 5, and 7 years were 87.8, 75.2, 73.5, and 72.6 %, respectively. In multivariate Cox regression analyses, tumor stage (HR 27.4; 95 % CI 7.83–95.8; p = 0.0001) and lymphovascular invasion (LVI) (HR 1.53; 95 % CI 1.22–3.12; p = 0.01) were independently associated with EUR. In patients with EUR, 5-year CSS estimate was 29.2 %. Tumor stage (HR 14.3; 95 % CI 4.55–45.2; p < 0.001) and EUR (HR 2.7; 95 % CI 1.54–4.73; p = 0.001) were the only independent predictors associated with worse CSS.

Conclusions

EUR significantly affected the prognosis in patients with UTUC managed by RNU. Patient with EUR had a greater probability of having higher tumor stages, higher tumor grades, and positive LVI. Tumor stage and LVI were independently associated with a worse EUR-free survival.

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Acknowledgments

This work was supported by the Ministry for Science and Technology of the Republic of Serbia, through Contact No. 175042 (2011–2014).

Conflict of interest

The authors declare that they have no conflict of interest.

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Author notes

    Authors and Affiliations

    1. Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Resavska 51, 11000, Belgrade, Serbia

      Zoran Dzamic, Bogomir Milojevic, Boris Kajmakovic & Nebojsa Bojanic

    2. Center of Nuclear Medicine, Clinical Center of Serbia, Belgrade, Serbia

      Isidora Grozdic Milojevic

    3. Institute of Epidemiology, School of Medicine, University of Belgrade, Belgrade, Serbia

      Sandra Sipetic Grujicic

    Authors
    1. Zoran Dzamic
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    2. Bogomir Milojevic
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    3. Boris Kajmakovic
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    4. Isidora Grozdic Milojevic
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    5. Nebojsa Bojanic
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    6. Sandra Sipetic Grujicic
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    Corresponding author

    Correspondence to Bogomir Milojevic.

    Additional information

    Zoran Dzamic and Bogomir Milojevic have contributed equally to this work.

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    Dzamic, Z., Milojevic, B., Kajmakovic, B. et al. Extraurothelial recurrence after radical nephroureterectomy: preoperative predictors and survival. Int Urol Nephrol 47, 775–779 (2015). https://doi.org/10.1007/s11255-015-0946-8

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    • DOI: https://doi.org/10.1007/s11255-015-0946-8

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