Clinical Outcomes in Patients with Panurothelial Carcinoma Treated with Radical Nephroureterectomy Following Cystectomy for Metachronous Recurrence

We report pathologic, functional, and oncologic outcomes in patients treated with radical nephroureterectomy following radical cystectomy.

We identified patients who underwent radical cystectomy then radical nephroureterectomy for metachronous urothelial recurrence at our institution between January 1995 and December 2014.

Univariable Cox regression was used to assess the association between overall survival and age, grade, stage, lymph node metastasis, and radiographic findings.

Of the 3173 radical cystectomy patients, 64 underwent subsequent radical nephroureterectomy for metachronous urothelial recurrence. Median age at radical cystectomy was 66 years (IQR 61-74). Of the 64 who underwent radical nephroureterectomy, the median time from radical cystectomy to radical nephroureterectomy was 2.7 years (IQR: 1.4-4.6). Among 37 patients that underwent ureteroscopy prior to radical nephroureterectomy, 29 (78%) had positive biopsy. Radical nephroureterectomy pathology revealed 39% locally advanced disease (pT3/pT4) and 11% positive node status compared with 17% locally advanced disease, and 6% positive node status from radical cystectomy pathology. Post- radical nephroureterectomy eGFR was <60 mL/min/1.73m(2) and <30 mL/min/1.73m(2) for 96% and 40% of patients, respectively. Median overall survival from radical nephroureterectomy was 3.1 years (95% CI: 2.4-4.3). Only lymph node involvement on radical nephroureterectomy was significantly associated with worse overall mortality (HR=2.73, 95% CI 1.04, 7.15, p=0.041).

Prognosis is poor for patients with panurothelial carcinoma treated with nephroureterectomy following cystectomy, with locally advanced disease in a large proportion of patients. Renal function after these procedures diminished and almost all patients were ineligible for cisplatin-based chemotherapy.

The Journal of urology. 2017 Mar 22 [Epub ahead of print]

Qiang Li, Melissa Assel, Eugene Pietzak, Aditya Bagrodia, Eugene Cha, Guido Dalbagni, Jonathan Coleman

Departments of Surgery, Urology Service., Department of Epidemiology-Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York., Departments of Surgery, Urology Service. Electronic address: .

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