International Urology and Nephrology

, Volume 47, Issue 5, pp 775–779 | Cite as

Extraurothelial recurrence after radical nephroureterectomy: preoperative predictors and survival

  • Zoran Dzamic
  • Bogomir Milojevic
  • Boris Kajmakovic
  • Isidora Grozdic Milojevic
  • Nebojsa Bojanic
  • Sandra Sipetic Grujicic
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.

Keywords

Extraurothelial recurrence Radical nephroureterectomy Survival Upper urinary tract urothelial carcinoma 
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Notes

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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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Zoran Dzamic
    • 1
  • Bogomir Milojevic
    • 1
  • Boris Kajmakovic
    • 1
  • Isidora Grozdic Milojevic
    • 2
  • Nebojsa Bojanic
    • 1
  • Sandra Sipetic Grujicic
    • 3
  1. 1.Clinic of Urology, Clinical Center of Serbia, School of MedicineUniversity of BelgradeBelgradeSerbia
  2. 2.Center of Nuclear MedicineClinical Center of SerbiaBelgradeSerbia
  3. 3.Institute of Epidemiology, School of MedicineUniversity of BelgradeBelgradeSerbia

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