Patient characteristics and outcomes in metastatic upper tract urothelial carcinoma after radical nephroureterectomy: the experience of Japanese multi‐institutions

Abstract

Objectives• To investigate oncological outcomes and prognostic factors in patients with upper tract urothelial carcinoma (UTUC) who experienced disease recurrence after radical nephroureterectomy (RNU).• Few studies have focused on the clinical courses of patients who experienced disease recurrence after RNU. Patients and Methods• A total of 204 UTUC patients who experienced disease recurrence from a retrospective multi-institutional cohort were included in the present study.• Associated patient outcomes were analyzed using multivariate analysis. Results• The mean time from RNU to first disease recurrence was 15.0 months and ª90% of patients experienced disease recurrence within the first 3 years after RNU.• During a median follow-up of 8.1 month after disease recurrence, 165 patients died from UTUC and five patients died from other causes. In the 204 cohorts, 1-and 3-year cancer-specific survival rates were 40.2% and 9.7%, respectively, and 1-and 3-year overall survival rates were 39.5% and 9.4%, respectively.• After disease recurrence, 132 patients underwent systemic chemotherapy, and a subgroup analysis of patients who underwent systemic chemotherapy multivariate analysis showed that performance status, the presence of liver metastasis and the number of recurrence sites were independently prognostic of cancer-specific and overall survival after relapsing. • According to three significant variables, 1-and 3-year cancer-specific survival rates were 72.7% and 20.8% in patients with no risk factors, 46.5% and 7.5% in patients with one risk factor, and 26.4% and 4.4% in patients with two or three risk factors, respectively (P < 0.001). Conclusions• Most patients died from UTUC within 3 years, even though systemic chemotherapies were administered after relapsing.• Multivariate analysis showed that performance status, the presence of liver metastasis and the number of recurrence sites were independently related to poor survival after systemic chemotherapy.

The comparison of oncologic outcomes between metastatic upper tract urothelial carcinoma and urothelial carcinoma of the bladder after cisplatin-based chemotherapy

“…Previous literatures have shown the survival prediction for metastatic UC after chemotherapy, mainly focusing on UCB [18][19][20][21][22][23][24][25][26]. There were limited studies to separately investigate or compare the prognostic factors between metastatic UTUC and UCB after cisplatin-based chemotherapy.…”

Do metastatic upper tract urothelial carcinoma and bladder carcinoma have similar clinical responses to systemic chemotherapy? A Japanese multi-institutional experience

“…Therefore, older UTUC patients receive systemic chemotherapy when recurrence/metastasis occurs. The mean ages of patients with recurrence and/or metastasis after total cystectomy and RNU were previously reported to be 65-66 years (22,23) and 72 years (24), respectively. Furthermore, due to a solitary functioning kidney after RNU, patients with recurrent/ metastatic UTUC were found to have lower renal function and, hence, non-cisplatin-based chemo-regimen was more likely to be selected.…”

Prognostic model to predict survival in patients with metastatic upper tract urothelial carcinoma treated with cisplatin‐based chemotherapy

“…Several major prognostic models were also validated by using our cohort, including the Bajorin model, 15 Taguchi model 16 and Tanaka model. 17 Harrell's c-index was calculated to evaluate their predicting performances.…”

“…Tanaka et al reported that PS, the presence of liver metastasis and the number of recurrence sites were independently related to poor survival of mUTUC after chemotherapy. 17 However, 17% received non-cisplatin-based chemotherapy. In the present study, we suggest that renal function, performance status, liver metastasis and number of metastatic sites have a significant impact on survival for mUTUC patients treated with cisplatin-based chemotherapy.…”