Open Access

ARTICLE

Factors impacting survival in patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy

Pascal Mouracade^1,2, Michel Velten², Marc Gigante³, Olivier Alenda¹, Guillaume Ploussard¹, Frederic Obadia³, Marc Olivier Timsit¹, Arnaud Mejean¹

1 Department of Urology, Université Paris Descartes, Paris, France
2 Department of Epidemiology and Public Health, University of Strasbourg, Strasbourg, France
3 Department of Urology, Saint Etienne Hospital, Saint Etienne, France
Address correspondence to Dr. Pascal Mouracade, Department of Urology, Necker Enfants-Malades Hospital, Paris, France

Canadian Journal of Urology 2012, 19(1), 6105-6110.

Abstract

Introduction: This study aims to assess the influence of different prognostic factors on the survival of upper tract urothelial carcinoma (UTUC) managed by nephroureterectomy and to investigate whether these factors have independent prognostic significance.
Materials and methods: A retrospective review of institutional databases from two teaching hospitals identified 269 consecutive patients with UTUC managed with nephroureterectomy between 1985 and 2005. The mean follow-up was 80.6 months (median 70.3 months), completed until January 2009. Tumor location and other clinicopathological variables were analyzed in relation to survival. Data collected included age, gender, tumor characteristics (pT stage, grade, lymph node status), tumor location, use of chemotherapy, and period of diagnosis. Tumor location was divided into two groups (renal pelvis and ureter) based on the tumor's origin.
Results: Five-year and 10-year overall survival estimates for this cohort were 71.3% and 40.0%, respectively. According to tumor location, survival was 73.6% and 47.0% for renal pelvis tumors versus 67.8% and 32.3% for ureteral tumors (log-rank test: p = 0.027). In multivariate analysis, T stage was the most significant prognostic factor (p < 0.001). Nodal involvement (p = 0.005), high grade (p < 0.001), earlier period of diagnosis (p < 0.001), and ureteral tumor location (p = 0.003) were significantly associated with lower survival rates. Prognosis of UTUC improved over time: survival was significantly better during the later diagnostic period (2001–2005) (p < 0.002).
Conclusions: Tumor location and diagnostic period should be considered as independent prognostic factors for upper tract urothelial carcinoma.

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