TY - JOUR
T1 - High rates of advanced disease, complications, and decline of renal function after radical nephroureterectomy
AU - Raman, Jay D.
AU - Lin, Yu Kuan
AU - Kaag, Matthew
AU - Atkinson, Timothy
AU - Crispen, Paul
AU - Wille, Mark
AU - Smith, Norm
AU - Hockenberry, Mark
AU - Guzzo, Thomas
AU - Peyronnet, Benoit
AU - Bensalah, Karim
AU - Simhan, Jay
AU - Kutikov, Alexander
AU - Cha, Eugene
AU - Herman, Michael
AU - Scherr, Douglas
AU - Shariat, Shahrokh F.
AU - Boorjian, Stephen A.
N1 - Copyright © 2014 Elsevier Inc. All rights reserved.
PY - 2014/1
Y1 - 2014/1
N2 - Objectives: Recurrences remain common following radical nephroureterectomy (RNU) for locally advanced upper-tract urothelial carcinoma (UTUC). We review a cohort of RNU patients to identify the incidence of locally advanced disease, decline in renal function, complications, and utilization of adjuvant chemotherapy (AC). Methods: Institutional databases from 7 academic medical centers identified 414 RNU patients treated between 2003 and 2012 who had not received neoadjuvant chemotherapy. Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease equation. Complications were classified according to the modified Clavien system. Cox proportional hazard modeling and Kaplan-Meier analysis determined factors associated with cancer-specific survival. Results: Of 414 patients, 177 (43%) had locally advanced disease, including 118 pT3N0/Nx, 13 pT4N0/Nx, and 46 pTanyN+. Estimated 3- and 5-year cancer-specific survival was 47% and 34%, respectively. Only 31% of patients with locally advanced UTUC received AC. Mean estimated glomerular filtration rate declined from 59 to 51ml/min/1.73m2 following RNU, including a new-onset decline below 60 and 45ml/min/1.73m2 in 25% and 15% of patients, respectively (P<0.001 for both). Complications occurred in 46 of 177 (26%) patients, of which one-quarter were grade III or IV. Increasing age (Hazard Ratio (HR) 1.4, P = 0.03), positive surgical margins (HR 2.1, P = 0.01), and positive lymph nodes (HR 4.3, P<0.001) were associated with an increased risk of death from UTUC, whereas receipt of AC (HR 0.85, P = 0.05) was associated with a decrease in UTUC mortality. Conclusions: Under one-third of RNU patients with locally advanced UTUC cancers received AC. Perioperative complications and decline in renal function may have contributed to this low rate. Such data further underscore the need for continued discussion regarding the use of chemotherapy in a neoadjuvant setting for appropriately selected patients with UTUC.
AB - Objectives: Recurrences remain common following radical nephroureterectomy (RNU) for locally advanced upper-tract urothelial carcinoma (UTUC). We review a cohort of RNU patients to identify the incidence of locally advanced disease, decline in renal function, complications, and utilization of adjuvant chemotherapy (AC). Methods: Institutional databases from 7 academic medical centers identified 414 RNU patients treated between 2003 and 2012 who had not received neoadjuvant chemotherapy. Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease equation. Complications were classified according to the modified Clavien system. Cox proportional hazard modeling and Kaplan-Meier analysis determined factors associated with cancer-specific survival. Results: Of 414 patients, 177 (43%) had locally advanced disease, including 118 pT3N0/Nx, 13 pT4N0/Nx, and 46 pTanyN+. Estimated 3- and 5-year cancer-specific survival was 47% and 34%, respectively. Only 31% of patients with locally advanced UTUC received AC. Mean estimated glomerular filtration rate declined from 59 to 51ml/min/1.73m2 following RNU, including a new-onset decline below 60 and 45ml/min/1.73m2 in 25% and 15% of patients, respectively (P<0.001 for both). Complications occurred in 46 of 177 (26%) patients, of which one-quarter were grade III or IV. Increasing age (Hazard Ratio (HR) 1.4, P = 0.03), positive surgical margins (HR 2.1, P = 0.01), and positive lymph nodes (HR 4.3, P<0.001) were associated with an increased risk of death from UTUC, whereas receipt of AC (HR 0.85, P = 0.05) was associated with a decrease in UTUC mortality. Conclusions: Under one-third of RNU patients with locally advanced UTUC cancers received AC. Perioperative complications and decline in renal function may have contributed to this low rate. Such data further underscore the need for continued discussion regarding the use of chemotherapy in a neoadjuvant setting for appropriately selected patients with UTUC.
KW - Age Factors
KW - Aged
KW - Aged, 80 and over
KW - Carcinoma, Transitional Cell/physiopathology
KW - Female
KW - Follow-Up Studies
KW - Glomerular Filtration Rate
KW - Humans
KW - Kaplan-Meier Estimate
KW - Kidney Function Tests
KW - Lymphatic Metastasis
KW - Male
KW - Middle Aged
KW - Nephrectomy/adverse effects
KW - Outcome Assessment, Health Care/methods
KW - Postoperative Complications
KW - Proportional Hazards Models
KW - Risk Factors
KW - Ureter/surgery
KW - Urologic Neoplasms/physiopathology
UR - http://www.scopus.com/inward/record.url?scp=84890792345&partnerID=8YFLogxK
UR - https://doi.org/10.1016/j.urolonc.2013.06.015
U2 - 10.1016/j.urolonc.2013.06.015
DO - 10.1016/j.urolonc.2013.06.015
M3 - Article
C2 - 24140248
SN - 1078-1439
VL - 32
SP - 47.e9-47.e14
JO - Urologic Oncology: Seminars and Original Investigations
JF - Urologic Oncology: Seminars and Original Investigations
IS - 1
ER -
