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Risk stratification of metastatic recurrence in invasive upper urinary tract carcinoma after radical nephroureterectomy without lymphadenectomy

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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).

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.

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).

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.

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Urology, Claude Huriez University Hospital, CHRU Lille, Lille, France

    Pierre Colin, Laurent Nison & Adil Ouzzane

  2. Department of Urology, Seclin Hospital, Seclin, France

    Pierre Colin

  3. Department of Urology, Foch University Hospital, Suresnes, France

    Tarek P. Ghoneim

  4. Service d’Urologie, Hopital Pitié-Salpétrière, AP-HP, 83 Bvd Hopital, 75013, Paris, France

    Thomas Seisen & Morgan Rouprêt

  5. Department of Urology, Nord University Hospital, AP-HM, Marseille, France

    Eric Lechevallier & Adil Ouzzane

  6. Department of Urology, Monstouris Insitute, Paris, France

    Xavier Cathelineau

  7. Department of Urology, Cochin University Hospital, AP-HP, Paris, France

    Marc Zerbib

  8. Department of Urology, Albert Michallon University Hospital, CHU Grenoble, Grenoble, France

    Jean-Alexandre Long

  9. Department of Urology, Lyon-Sud University Hospital, Lyon, France

    Alain Ruffion

  10. Department of Urology, Edouard Herriot University Hospital, Lyon, France

    Sébastien Crouzet

  11. Department of Urology, Tenon University Hospital, AP-HP, Paris, France

    Olivier Cussenot

  12. Department of Urology, Val de Grâce Military Hospital, Paris, France

    Marie Audouin

  13. Department of Urology, Jean Bernard University Hospital, CHU Poitiers, Poitiers, France

    Jacques Irani

  14. Department of Urology, Dupuytren University Hospital, CHU Limoges, Limoges, France

    Solène Gardic

  15. Department of Urology, Carémeau University Hospital, CHU Nimes, Nimes, France

    Pascal Gres

  16. Department of Urology, HEGP University Hospital, AP-HP, Paris, France

    François Audenet

  17. Department of Urology, Rangueil University Hospital, CHU Toulouse, Toulouse, France

    Mathieu Roumiguié

  18. Department of Urology, Cavale Blanche University Hospital, CHU Brest, Brest, France

    Antoine Valeri

  19. Institut Universitaire de Cancérologie, GRC5, ONCOTYPE-Uro, Université Paris 6, Paris, France

    Thomas Seisen & Morgan Rouprêt

Authors
  1. Pierre Colin
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  2. Tarek P. Ghoneim
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  3. Laurent Nison
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  4. Thomas Seisen
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  5. Eric Lechevallier
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  6. Xavier Cathelineau
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  7. Adil Ouzzane
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  8. Marc Zerbib
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  9. Jean-Alexandre Long
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  10. Alain Ruffion
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  11. Sébastien Crouzet
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  12. Olivier Cussenot
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  13. Marie Audouin
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  14. Jacques Irani
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  15. Solène Gardic
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  16. Pascal Gres
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  17. François Audenet
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  18. Mathieu Roumiguié
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  19. Antoine Valeri
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  20. Morgan Rouprêt
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Corresponding authors

Correspondence to Pierre Colin or Morgan Rouprêt.

Additional information

The study was conducted for the French Collaborative National Database of UTUC.

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Colin, P., Ghoneim, T.P., Nison, L. et al. Risk stratification of metastatic recurrence in invasive upper urinary tract carcinoma after radical nephroureterectomy without lymphadenectomy. World J Urol 32, 507–512 (2014). https://doi.org/10.1007/s00345-013-1116-1

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  • DOI: https://doi.org/10.1007/s00345-013-1116-1

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