Prognostic factors in urothelial renal pelvis and ureter tumours: a multicentre Rare Cancer Network study

Abstract

To assess the prognostic factors in patients with transitional-cell carcinoma of the renal pelvis and/or ureter, a series of 138 patients with transitional-cell carcinoma of the renal pelvis and/or ureter was collected in a retrospective multicentre study. 12 patients with distant metastases were excluded from the statistical evaluation. All but 3 patients underwent radical surgery: nephroureterectomy (n = 71), nephroureterectomy and lymphadenectomy (n = 20), nephroureterectomy and partial bladder resection or transurethral resection (n = 20), nephrectomy (n = 10), and ureterectomy (n = 5). Sixty-one per cent (n = 77) of the tumours were located in the renal pelvis, and 21% (n = 27) in the ureter (both in 22 [17%]). Following surgery, residual tumour was still present in 33 patients (16 microscopic and 17 macroscopic). Postoperative radiotherapy was given to 45 (36%) patients. The median follow-up period was 39 months. In a median period of 9 months, 66% of the patients relapsed (34 local, 7 locoregional, 16 regional, and 24 distant). The 5-and 10-year survival were 29% and 19%, respectively, in all patients. In univariate analyses, statistically signi®cant factors in¯uencing the outcome were Karnofsky index, pT-classi®cation, pN-classi®cation, tumour localisation, grade, and residual tumour after surgery. Multivariate analysis revealed that independent prognostic factors in¯uencing outcome were pTclassi®cation, the existence of residual tumour, and tumour localisation. In patients with urothelial renal pelvis and/or ureter tumours, a radical surgical attitude is mandatory; and the presence of tumour in the ureter is associated with a poorer prognosis. #

pT classification, grade, and vascular invasion as prognostic indicators in urothelial carcinoma of the upper urinary tract

“…Similar observations have been made in other studies, 8,11,12,[15][16][17][22][23][24] whereas only one investigation has identified tumor grade as an independent predictor of overall survival, but not of cancer-specific survival in patients with upper tract cancer. 18 The new two-tiered grading system, however, has only twice before been applied with respect to prognostic impact in upper urinary tract tumors.…”

“…5,8,[10][11][12][13][15][16][17]20,22,24,25 Regarding pT3 pelvic cancer, our data demonstrating significantly poorer outcome of patients with UCs showing macroscopic parenchyma and/or fat invasion compared with patients with UCs showing microscopic parenchyma invasion only are in line with two previous studies. 35,36 They reported that pT3 UCs with extensive parenchymal invasion (defined as invasion deeper than 5 mm) had a prognosis similar to that of pT4 tumors, whereas pT3 UCs without extensive parenchymal invasion (including cases with intraductal spread only) had a prognosis similar to that of pT1/pT2 disease.…”

“…2,8,11,12,[14][15][16][17][18][20][21][22][23][24][25]29,[32][33][34] Thus, the identification of independent prognostic variables is an essential step to predict disease evolution, thus aiding surveillance strategies, and also to identify patient subgroups that might benefit from adjuvant cancer therapy. Our study is by far the largest systematic investigation of the impact of pT classification, tumor grade, as well as vascular invasion in patients with both pelvic and ureteral UCs with respect to metastasis-free survival.…”

Highly predictive survival nomogram after upper urinary tract urothelial carcinoma

“…[1][2][3][4][5] The pathological T and N categories and pathologically defined tumor grade are powerful indicators of prognosis. [6][7][8][9][10][11] However, to date, the ability of the combined input from pathological stage, grade, and other tumor and patient characteristics has never been examined with respect to prediction of cancer-specific mortality after nephroureterectomy. In the current study, we hypothesized that, like in other malignancies, pT and pN stages combined with tumor grade and patient characteristics, such as age and sex, could highly accurately predict the probability of cancerspecific mortality.…”

Independent predictors of cancer‐specific survival in transitional cell carcinoma of the upper urinary tract

“…3 The knowledge of prognostic factors for UUT-TCC often is based on studies on the most common bladder TCC, and only a few studies on prognostic factors for UUT-TCC have been published to date, and those sometimes have reported conflicting data. Tumor stage [4][5][6][7][8][9][10][11] and histologic grade 7,11,12 are among the best established prognostic factors; whereas, conversely, the roles of other potentially relevant variables, such as a history of bladder cancer, tumor site, lymphovascular invasion, or multifocality, are less clear. [6][7][8]10,11 A clear knowledge of those prognostic data would be useful for counseling patients after surgery and for identifying those patients with unfavorable cancer-related outcome who may be candidates for future neoadjuvant or adjuvant randomized controlled trials.…”