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Upper tract urothelial carcinoma is an uncommon malignancy accounting for 3-5% of all urothelial tumors. Nephroureterectomy with bladder cuff excision is the standard management of high grade or bulky upper tract disease. Due to the relatively rare nature of this disease, there is a paucity of data regarding long-term oncologic outcomes. We present our oncologic outcomes for nephroureterctomy with bladder cuff excision.METHODS: We performed a retrospective analysis of our prospectively maintained IRB approved database of robotic nephroureteretomy. We included all cases from May 2006 until the present with at least 6 months of follow up. We evaluated oncologic outcomes based on T stage, lymph node status, age, sex, presence of concomitant CIS and surgical margin status. All data was analyzed by an epidemiologist at the Wake Forest University School of Public Health using SPSS.RESULTS: 151 nephroureterectomies were identified with at least 6 months of follow up. Pathologic T stage was a significant factor in overall survival with median survival 3.8 years (T0), 5.5 years (T1), 4.8 years (T2), 2.1years (T3) and 1.4 year (T4) (p¼0.028). Older patients did worse with each 5 year increase in age had a proportionate increase in mortality (p¼0.002) with hazard ratio of 1.27 (1.09-1.48). Margin status did have a significant influence on outcomes with margin positive patient having a median survival of 1.9 years versus 3.8 years for margin negative patients (p¼0.0008). Gender (p¼0.14), concomitant CIS (p¼0.92), and lymph node positive disease (p¼0.21). did not significantly change outcomes for this group of patients.CONCLUSIONS: Patients have progressively worse outcomes with increasing age with significant increase in mortality after age 70. Patients with high-grade disease and margin positive disease have higher all cause mortality after surgery. Interestingly, lymph node status did not affect long-term outcomes. Further studies with more patients are needed to help refine our knowledge of outcomes after nephroureterectomy for upper tract urothelial carcinoma.

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