TAIPEI, TAIWAN (UroToday.com) - Introduction and Objectives: Upper urinary tract urothelial carcinoma (UTUC) accounts for approximately 5% in all urothelial tumors. While several independent risk factors have been reported, a potential prognostic variable would be the multifocality within the upper urinary tract. The aim of this study was to assess the impact of tumor multifocality for clinical outcomes in patients treated with RNU for UTUC.
Methods: This study included the 196 patients who had been diagnosed with UTUC based on pathological examination. From January 1975 to April 2014, we retrospectively reviewed the association of tumor location with clinical outcomes in the consecutive patients treated with RNU.
Results: Overall, 111 tumors were located in the renal pelvis and 49 in the ureter. Thirty-six tumors were classified as mutifocality, involving both renal pelvis and ureter. Fifty-eight patients were treated with laparoscopic RNU and 138 patients underwent openRNU. Lymphadenectomywas performed in 105 patients. The Kaplan-Meier method showed that tumor multifocality was associated with worse cancer-specific survival (CSS) (p = 0.04). On multivariate analysis, tumormultifocality (HR 4.6, p = 0.03), grade (HR 5.3, p = 0.03) and lymph node status (HR 8.3, p < 0.01) were independent prognostic factors for CSS. However, surgical procedure, including laparoscopic procedure and open one, was not prognostic factor in the same analysis (HR 0.5, p = 0.4).
Conclusions: Tumor multifocality was an independent prognostic factor for CSS. In addition, surgical procedure was not associated with CSS. Patients with multifocal disease would be candidates for requiring adjuvant therapy and may need to be close follow-up.
Source of Funding: None
|Listen to an interview with Takahiro Hirayama, one of the authors of this study.|
Presented by Takahiro Hirayama, Kazumasa Matsumoto, Morihiro Nishi, Hideyasu Tsumura, Ken-ichi Tabata, Daisuke Ishii, Tetsuo Fujita, and Masatsugu Iwamura at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan
Department of Urology, Kitasato University School of Medicine, Japan