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

TLDR

UTUC research has largely been limited to small, single‑center studies. This study evaluated 1,363 UTUC patients undergoing radical nephroureterectomy to identify prognostic factors. Data from 12 academic centers were compiled and all pathology slides were re‑reviewed by genitourinary pathologists using strict criteria. During a median 51‑month follow‑up, 28% of patients experienced recurrence and 23% died, with 5‑year recurrence‑free and cancer‑specific survival rates of 69% and 73%, respectively, and multivariate analysis showing that high tumor grade, advanced T stage, lymph node metastases, infiltrative growth, and lymphovascular invasion predicted recurrence, while age, grade, T stage, lymph node status, sessile architecture, and lymphovascular invasion predicted cancer‑specific survival, highlighting these variables as key prognostic indicators for selecting patients for adjuvant therapy.

Abstract

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.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.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.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.