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Margulis, V; Shariat, SF; Matin, SF; Kamat, AM; Zigeuner, R; Kikuchi, E; Lotan, Y; Weizer, A; Raman, JD; Wood, CG; Upper Tract Urothelial Carcinoma CollaborationThe Upper Tract Urothelial Carcinoma Collaboration.
Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration.
Cancer. 2009; 115(6): 1224-1233. [OPEN ACCESS]
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Autor/innen der Med Uni Graz:
Zigeuner Richard
Study Group Mitglieder der Med Uni Graz:
Langner Cord
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Abstract:
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. Cancer 2009;115:1224-33. (C) 2009 American Cancer Society.
Find related publications in this database (using NLM MeSH Indexing)
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

Find related publications in this database (Keywords)
transitional cell carcinoma
urothelial carcinoma
radical nephroureterectomy
prognostic factors
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