Cancer-specific survival in patients with upper tract urothelium carcinoma after radical nephroureterectomy

Abstract

Introduction: Identifying prognostic factors is essential for proper postoperative patient monitoring with upper urinary tract carcinoma, that would contribute to the decision-making process regarding the application of adjuvant chemotherapy after radical nephroureterectomy. Aim: To investigate demographic, clinical, and pathological prognostic factors of cancer-specific survival (CSS) for upper urothelial tumors. Methods: A retrospective cohort study was conducted including 342 patients who underwent radical nephroureterectomy. Kaplan-Meier method and LogRank test were used to assess survival. Cox regression analysis was used to determine the impact of different factors on cancer-specific survival after radical nephroureterectomy. Results: The study cohort consisted of 342 patients, with a mean follow-up time after radical nephroureterectomy of 32.5 (6-154) months. The 5-year CSS was 64% for this patient cohort. During the follow-up period, a total of 128 (37.4%) patients died, including 92 (28.2%) patients who died due to urothelial carcinoma. Multivariate analysis showed that the pathological stage of the primary tumor (HR, 11.1; 95% CI 3.64-33.8; P=0.001), presence of positive lymph nodes (HR, 2.04; 95% CI 1.05-3.94; P=0.03) and preoperative anemia (HR, 3.50; 95% CI 2.02-6.08; P=0.001) were independent predictors significantly associated with worse CSS. Patients with disease stage ≤ pT2 had significantly better CSS compared to patients with disease stage ≥ pT3 (P=0.001, Log-Rank test). The average CSS for patients with positive lymph nodes (pN+) was 22.1 ± 5.1 months (95% confidence interval from 12.1-32.2). Conclusion: Preoperative anemia, pathological disease stage, and presence of positive lymph nodes are significant independent prognostic predictors of CSS in patients who underwent radical nephroureterectomy (RNU).