Ureteral location is associated with survival outcomes in upper tract urothelial carcinoma: A population‐based analysis

Abstract

Objectives: To evaluate the prognostic value of tumor location in patients with upper tract urothelial carcinoma. Methods: Within the Surveillance, Epidemiology and End Results Incidence Database, 6619 upper tract urothelial carcinoma cases were identified, including 3719 confined to the renal pelvis and 2971 to the ureter. Predictors of surgical technique (kidney sparing surgery versus radical nephroureterectomy), as well as 2-and 5-year cancer-specific survival and overall survival were evaluated. Results: Median follow-up time was 29 months (interquartile range 0-126 months) for both groups. Multivariate logistic analysis showed tumor dimension as the only factor associated with radical nephroureterectomy (odds ratio 1.02; P < 0.001). Ureteral 2-and 5-year overall survival were lower (log-rank P = 0.001) compared with renal pelvis. When stratifying tumor location according to dimensions, a ureteral carcinoma >3 cm was associated with the worst 2-and 5-year cancer-specific mortality (Pepe-Mori P < 0.001), and overall survival (log-rank P < 0.001). The 2-and 5-year cancer-specific mortality (Pepe-Mori P < 0.001) and overall survival were the worst for ureteral ≥T3 tumors (log-rank P < 0.001). The 2-and 5-year cancer-specific mortality (Pepe-Mori P < 0.001) and overall survival (log-rank P < 0.001) were the worst for ureteral grade III-IV cancers. Ureteral tumor location (subdistribution hazard ratio 1.18, P < 0.001), tumor dimension ≥3 (subdistribution hazard ratio 1.25, P < 0.001), T staging (T2-4 all P < 0.001), grading (grade III subdistribution hazard ratio 2.20, P = 0.001; grade IV subdistribution hazard ratio 2.39, P < 0.001) were found to be associated with higher cancer mortality. Conclusions: Ureteral tumor location in upper tract urothelial carcinoma seems to be associated with worse oncological outcomes, especially in the case of advanced disease. Although the type of surgical treatment does not seem to impact survival, surgeons should use caution in adopting a kidney-sparing surgery for patients with ureteral upper tract urothelial carcinoma.

The Impact of Primary Tumor Location on Long-Term Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

“…Data for CSS were extractable from 14 studies [8,9,[11][12][13][15][16][17][18][19][20][21]23,24]. Pooled results indicated that patients with UT had significantly worse CSS after RNU (HR: 1.37, 95% CI: 1.19-1.57, p < 0.001) compared to patients with RPT (Figure 3).…”

“…Significant between-study heterogeneity was observed (p = 0.03 and I 2 = 47%); thus, a random-effect model was used for data synthesis. Data for OS were extractable from 7 studies [8,[14][15][16]18,19,23]. A pooled results indicated that patients with UT had significantly worse OS after RNU (HR: 1.26, 95% CI: 1.08-1.46, p = 0.003) compared to patients with RPT (Figure 4).…”

“…Eventually, there were 15 studies left, together with 2 studies selected from the references of relative articles. Thus, a total of 17 studies were included for final quantitative and qualitative synthesis [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24].…”

“…All trials had retrospective design. Of the 17 studies, 9 [8,10,12,16,18,20,[22][23][24] presented data from Asian populations, while the remaining articles reported data from European (3 studies [13][14][15]), North American (3 studies [9,11,19]), and international populations (2 studies [17,21]). The duration of follow-up (median or mean) ranged from 21 to 73 months.…”

“…The clinicopathological characteristics of included articles are presented in Table 2. One study [10] provided clinicopathological data for the total cohort of patients (including both RPT and UT), and one study [19] did not report clinicopathological data for the analyzed subset of patients who underwent RNU. Male predominance was observed in the vast majority of papers.…”