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Risk stratification of metastatic recurrence in invasive upper urinary tract carcinoma after radical nephroureterectomy without lymphadenectomy.
- Source :
-
World journal of urology [World J Urol] 2014 Apr; Vol. 32 (2), pp. 507-12. Date of Electronic Publication: 2013 Jun 29. - Publication Year :
- 2014
-
Abstract
- Purpose: To assess the risk factors of metastasis relapse in pT2-3 upper tract urothelial carcinomas (UTUCs) treated by radical nephroureterectomy (RNU) without lymphadenectomy (LN).<br />Methods: A multicentric retrospective study was performed for pT2-3 pNx UTUCs treated by RNU between 1995 and 2010. The following criteria were retrieved: age, gender, American Society of Anaesthesiologists physical status, surgical approach, preoperative hydronephrosis, stage, grade, tumor location, surgical margin, lymphovascular invasion (LVI) status and outcomes. Metastasis-free survival (MFS) was measured by Kaplan-Meier method with the log-rank test.<br />Results: Overall, 151 patients were included. The median follow-up was 18.5 months (IQR 9.5-37.9). The 2- and 5-year MFS were 69 % ± 4.5 and 54.1 % ± 5.8, respectively. In univariate analysis, ureteral location, pT3 stage, positive LVI status and positive surgical margin were significantly associated with worse MFS (p = 0.03; 0.02; 0.01 and 0.006, respectively). In the multivariate analysis of ureteral location and pT3 stage were independent prognostic factors (p = 0.03 and 0.03, respectively). Based on the results of the univariate analysis, we proposed a risk model predicting MFS, which classifies patients into 3 categories with different overall survival (p < 0.001).<br />Conclusion: In view of our data, tumor location, T stage, LVI and surgical margin status are mandatory to predict survival in case of RN without LN. Contingent upon external validation, our risk model based on these variables could be useful to provide relevant information concerning metastasis relapse probability and necessity of close follow-up for these patients.
- Subjects :
- Aged
Carcinoma, Transitional Cell pathology
Disease-Free Survival
Female
Humans
Kaplan-Meier Estimate
Kidney Neoplasms pathology
Kidney Pelvis pathology
Lymph Node Excision
Male
Middle Aged
Multivariate Analysis
Neoplasm Metastasis
Neoplasm Staging
Neoplasm, Residual
Neoplasms, Multiple Primary pathology
Prognosis
Retrospective Studies
Risk Assessment
Ureteral Neoplasms pathology
Carcinoma, Transitional Cell surgery
Kidney Neoplasms surgery
Kidney Pelvis surgery
Neoplasm Recurrence, Local
Neoplasms, Multiple Primary surgery
Nephrectomy methods
Ureter surgery
Ureteral Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1433-8726
- Volume :
- 32
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- World journal of urology
- Publication Type :
- Academic Journal
- Accession number :
- 23812497
- Full Text :
- https://doi.org/10.1007/s00345-013-1116-1