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Concomitant carcinoma in situ as an independent prognostic parameter for recurrence and survival in upper tract urothelial carcinoma: a multicenter analysis of 772 patients

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Abstract

Purpose

The purpose of this study is to assess the association of concomitant carcinoma in situ (CIS) with disease recurrence and cancer-related death in a multi-institutional series of patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).

Methods

We collected retrospectively the data of 772 patients treated with RNU and ipsilateral bladder cuff excision at 9 international institutions in Asia, Europe, and Northern America from 1987 to 2008. Surgical specimens were processed according to standard pathologic procedures at each institution. Univariable and multivariable Cox regression models addressed time to recurrence and cancer-specific mortality.

Results

Concomitant CIS was present in 88 patients (11.4%); it was associated with more advanced pathologic stage, higher tumor grade, and presence of lymphovascular invasion (all P-values < 0.05). The five-year recurrence-free (RFS) and cancer-specific survival (CSS) estimates were 74.4 and 76.3%, respectively, in the absence of CIS compared with 56.4 and 59.9%, respectively, in the presence of CIS (P-values < 0.0001 for RFS and 0.002 for CSS, respectively). On multivariable Cox regression analyses, concomitant CIS was an independent predictor of both RFS (hazard ratio (HR): 1.9; P = 0.007) and CSS (HR: 1.7, P = 0.048). Similar findings were reconfirmed in subgroups analyses limited to T2, organ confined, and N0/Nx UTUC, or patients who did not receive adjuvant chemotherapy.

Conclusions

Presence of concomitant CIS is an independent predictor of both RFS and CSS in patients treated with RNU for UTUC. This information may be useful in risk stratification of UTUC patients for follow-up and additional therapy.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany

    Wolfgang Otto, Hans-Martin Fritsche & Maximilian Burger

  2. Department of Urology, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY, 10021, USA

    Shahrokh F. Shariat & Amit Gupta

  3. Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

    Kazumasa Matsumoto & Shiro Baba

  4. McGill University Health Centre, Montreal, QC, Canada

    Wassim Kassouf

  5. University of Verona, Verona, Italy

    Guido Martignoni

  6. Royal Derby Hospital, Derby, UK

    Thomas J. Walton

  7. Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany

    Stefan Tritschler & Patrick J. Bastian

  8. Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain

    Juan I. Martínez-Salamanca

  9. General Hospital Bolzano, Bolzano, Italy

    Christian Seitz & Armin Pycha

  10. University of Montréal, Montreal, QC, Canada

    Pierre I. Karakiewicz

  11. University of Padua, Padua, Italy

    Vincenzo Ficarra & Giacomo Novara

Authors
  1. Wolfgang Otto
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  2. Shahrokh F. Shariat
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  3. Hans-Martin Fritsche
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  4. Amit Gupta
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  5. Kazumasa Matsumoto
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  6. Wassim Kassouf
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  7. Guido Martignoni
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  8. Thomas J. Walton
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  9. Stefan Tritschler
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  10. Shiro Baba
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  11. Patrick J. Bastian
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  12. Juan I. Martínez-Salamanca
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  13. Christian Seitz
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  14. Armin Pycha
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  15. Maximilian Burger
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  16. Pierre I. Karakiewicz
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  17. Vincenzo Ficarra
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  18. Giacomo Novara
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Corresponding author

Correspondence to Shahrokh F. Shariat.

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Otto, W., Shariat, S.F., Fritsche, HM. et al. Concomitant carcinoma in situ as an independent prognostic parameter for recurrence and survival in upper tract urothelial carcinoma: a multicenter analysis of 772 patients. World J Urol 29, 487–494 (2011). https://doi.org/10.1007/s00345-011-0645-8

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  • DOI: https://doi.org/10.1007/s00345-011-0645-8

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