Objectives: To determine the predictors of urothelial recurrence, distant metastases, and disease-specific survival (DSS) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
Methods: The records of 136 patients who underwent RNU in our department between 1983 and 2004 were reviewed. The study population consisted of 116 patients from whom tumor specimens were available for re-evaluation, focusing on pathologic tumor (pT) stage, grade, lymphovascular invasion (LVI), concomitant carcinoma in situ (CIS), and the presence of significant tumor necrosis. Univariate and multivariate analyses were performed.
Results: The median follow-up was 38 months (range: 1-193 months). At actual follow-up, 63 patients (56%) were alive and disease-free. Concomitant CIS independently predicted urothelial recurrence (P = .008). Five-year actual DSS by pT stage was 100% for pTa and pTis, 95% for pT1, 70% for pT2, 54% for pT3, and 14% for pT4 tumors. Disease-specific mortality occurred in 32 patients (28%). A sessile tumor architecture, pT stage, grade, the presence of LVI (all P < .001), a positive surgical margin (P = .012), tumor necrosis (P = .004), and lymph node metastases (P = .034) were significantly associated with reduced DSS on univariate analysis. Multivariate analysis revealed the presence of LVI (P < .001) and pT stage (P = .023) as independent predictors for reduced DSS.
Conclusions: RNU provides adequate local control and long-term DSS in patients with localized UTUC. LVI and pT stage are independent predictors for reduced DSS and can be used for the identification of patients who are likely to benefit from adjuvant therapies.