Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration

Cancer. 2009 Mar 15;115(6):1224-33. doi: 10.1002/cncr.24135.


Background: The literature on upper tract urothelial carcinoma (UTUC) has been limited to small, single center studies. A large series of patients treated with radical nephroureterectomy for UTUC were studied, and variables associated with poor prognosis were identified.

Methods: Data on 1363 patients treated with radical nephroureterectomy at 12 academic centers were collected. All pathologic slides were re-reviewed by genitourinary pathologists according to strict criteria.

Results: Pathologic review revealed renal pelvis location (64%), necrosis (21.6%), lymphovascular invasion (LVI) (24.8%), concomitant carcinoma in situ (28.7%), and high-grade disease (63.7%). A total of 590 patients (43.3%) underwent concurrent, lymphadenectomy and 135 (9.9%) were lymph node (LN) -positive. Over a mean follow-up of 51 months, 379 (28%) patients experienced disease recurrence outside of the bladder and 313 (23%) died of UTUC. The 5-year recurrence-free and cancer-specific survival probabilities (+/-SD) were 69%+/-1% and 73%+/-1%, respectively. On multivariate analysis, high tumor grade (hazards ratio [HR]: 2.0, P<.001), advancing pathologic T stage (P-for-trend<.001), LN metastases (HR: 1.8, P<.001), infiltrative growth pattern (HR: 1.5, P<.001), and LVI (HR: 1.2, P=.041) were associated with disease recurrence. Similarly, patient age (HR: 1.1, P=.001), high tumor grade (HR: 1.7, P=.001), increasing pathologic T stage (P-for-trend<.001), LN metastases (HR: 1.7, P<.001), sessile architecture (HR: 1.5, P=.002), and LVI (HR: 1.4, P=.02) were independently associated with cancer-specific survival.

Conclusions: Radical nephroureterectomy provided durable local control and cancer-specific survival in patients with localized UTUC. Pathologic tumor grade, T stage, LN status, tumor architecture, and LVI were important prognostic variables associated with oncologic outcomes, which could potentially be used to select patients for adjuvant systemic therapy.

MeSH terms

  • Aged
  • Carcinoma, Transitional Cell / pathology
  • Carcinoma, Transitional Cell / surgery*
  • Disease-Free Survival
  • Female
  • Humans
  • Male
  • Multicenter Studies as Topic
  • Neoplasm Recurrence, Local
  • Nephrectomy*
  • Prognosis
  • Treatment Outcome
  • Ureter / surgery*
  • Ureteral Neoplasms / pathology
  • Ureteral Neoplasms / surgery
  • Urologic Neoplasms / mortality
  • Urologic Neoplasms / pathology
  • Urologic Neoplasms / surgery*