Annals of Surgical Oncology

, Volume 19, Issue 13, pp 4337–4344

Risk of Cancer-specific Mortality following Recurrence After Radical Nephroureterectomy

  • Michael Rink
  • Daniel Sjoberg
  • Evi Comploj
  • Vitaly Margulis
  • Evanguelos Xylinas
  • Richard K. Lee
  • Jens Hansen
  • Eugene K. Cha
  • Jay D. Raman
  • Mesut Remzi
  • Karim Bensalah
  • Giacomo Novara
  • Surena F. Matin
  • Felix K. Chun
  • Eiji Kikuchi
  • Wassim Kassouf
  • Juan I. Martinez-Salamanca
  • Yair Lotan
  • Christian Seitz
  • Armin Pycha
  • Richard Zigeuner
  • Pierre I. Karakiewicz
  • Douglas S. Scherr
  • Andrew J. Vickers
  • Shahrokh F. Shariat
Urologic Oncology

DOI: 10.1245/s10434-012-2499-8

Cite this article as:
Rink, M., Sjoberg, D., Comploj, E. et al. Ann Surg Oncol (2012) 19: 4337. doi:10.1245/s10434-012-2499-8

Abstract

Purpose

To describe the natural history and identify predictors of cancer-specific survival in patients who experience disease recurrence after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).

Methods

Of 2,494 UTUC patients treated with RNU without neoadjuvant chemotherapy, 597 patients experienced disease recurrence. A total of 148 patients (25 %) received adjuvant chemotherapy before disease recurrence. Multivariable Cox regression model addressed time to cancer-specific mortality after disease recurrence.

Results

The median time from RNU to disease recurrence was 12 months (interquartile range 5–22). A total of 491 (82 %) of 597 patients died from UTUC, and 8 patients (1.3 %) died from other causes. The median time from disease recurrence to death of UTUC was 10 months. Actuarial cancer-specific survival estimate at 12 months after disease recurrence was 35 %. On multivariable analysis that adjusted for the effects of standard clinicopathologic characteristics, higher tumor stages [hazard ratio (HR) pT3 vs. pT0–T1: 1.66, p = 0.001; HR pT4 vs. pT0–T1: 1.90, p = 0.002], absence of lymph node dissection (HR 1.28, p = 0.041), ureteral tumor location (HR 1.44, p < 0.0005) and a shorter interval from surgery to disease recurrence (p < 0.0005) were significantly associated with cancer-specific mortality. The adjusted 6-, 12- and 24-month postrecurrence cancer-specific mortality was 73, 60 and 57 %, respectively.

Conclusions

Approximately 80 % of patients who experience disease recurrence after RNU die within 2 years after recurrence. Patients with non-organ-confined stage, absence of lymph node dissection, ureteral tumor location and/or shorter time to disease recurrence died of their tumor more quickly than their counterparts. These factors should be considered in patient counseling and risk stratification for salvage treatment decision making.

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Michael Rink
    • 1
    • 2
  • Daniel Sjoberg
    • 3
  • Evi Comploj
    • 4
  • Vitaly Margulis
    • 5
  • Evanguelos Xylinas
    • 1
    • 6
  • Richard K. Lee
    • 1
  • Jens Hansen
    • 2
    • 7
  • Eugene K. Cha
    • 1
  • Jay D. Raman
    • 8
  • Mesut Remzi
    • 9
  • Karim Bensalah
    • 10
  • Giacomo Novara
    • 11
  • Surena F. Matin
    • 12
  • Felix K. Chun
    • 2
  • Eiji Kikuchi
    • 13
  • Wassim Kassouf
    • 14
  • Juan I. Martinez-Salamanca
    • 15
  • Yair Lotan
    • 5
  • Christian Seitz
    • 16
  • Armin Pycha
    • 4
  • Richard Zigeuner
    • 17
  • Pierre I. Karakiewicz
    • 7
  • Douglas S. Scherr
    • 1
  • Andrew J. Vickers
    • 3
  • Shahrokh F. Shariat
    • 1
  1. 1.Weill Cornell Medical College, New York Presbyterian HospitalNew YorkUSA
  2. 2.University Medical Center Hamburg-EppendorfHamburgGermany
  3. 3.Memorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.General Hospital of BolzanoBolzanoItaly
  5. 5.University of Texas Southwestern Medical CenterDallasUSA
  6. 6.Cochin Hospital, APHP, Paris Descartes UniversityParisFrance
  7. 7.University of MontréalMontrealCanada
  8. 8.Penn State Milton S. Hershey Medical CenterHersheyUSA
  9. 9.Hospital Weinviertel-KorneuburgKorneuburgAustria
  10. 10.University of RennesRennesFrance
  11. 11.University of PaduaPaduaItaly
  12. 12.MD Anderson Cancer CenterHoustonUSA
  13. 13.Keio University School of MedicineTokyoJapan
  14. 14.McGill University Health CenterMontrealCanada
  15. 15.University Hospital Puerta de Hierro-MajadahondaMadridSpain
  16. 16.St. John of God Hospital, Teaching Hospital of the Medical UniversityViennaAustria
  17. 17.Medical University of GrazGrazAustria