Predictors of survival in patients with disease recurrence after radical nephroureterectomy. (June 2014)

• Record Type: Journal Article
• Authors: Kluth, Luis A.; Xylinas, Evanguelos; Kent, Matthew; Hagiwara, Masayuki; Kikuchi, Eiji; Ikeda, Masaomi; Matsumoto, Kazumasa; Dalpiaz, Orietta; Zigeuner, Richard; Aziz, Atiqullah; Fritsche, Hans‐Martin; Deliere, Amanda; Raman, Jay D.; Bensalah, Karim; Al‐Matar, Bikheet; Gakis, Georgios; Novara, Giacomo; Klatte, Tobias; Remzi, Mesut; Comploj, Evi; Pycha, Armin; Rouprêt, Morgan; Tagawa, Scott T.; Chun, Felix K.‐H.; Scherr, Douglas S.; Vickers, Andrew J.; Shariat, Shahrokh F.
• Is Part Of: BJU international. Volume 113:Number 6(2014:Jun.)
• Page Start: 911
• Page End: 917
• Publication Date: 2014-06
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12369
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12369-sec-0001" sec-type="section"> <title>Objectives</title> <p> <list id="bju12369-list-0001" list-type="bullet"> <list-item> <p>To evaluate the prognostic value of the Bajorin criteria in a multi‐institutional cohort of patients with disease recurrence after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).</p> </list-item> <list-item> <p>To investigate whether clinical, pathological and/or biological factors at time of disease recurrence are also associated with cancer‐specific outcomes in these patients.</p> </list-item> </list> </p> </sec> <sec id="bju12369-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12369-list-0002" list-type="bullet"> <list-item> <p>We identified 242 patients with disease recurrence after RNU for UTUC from 11 centres.</p> </list-item> <list-item> <p>With regard to the Bajorin criteria, patients were categorized into three groups based on two risk factors: Karnofsky performance status <80% and the presence of visceral metastasis.</p> </list-item> <list-item> <p>Assessed variables included pathological characteristics, time to disease recurrence, age‐adjusted Charlson comorbidity index (ACCI), American Society of Anesthesiologists (ASA) score, and laboratory tests at time of disease recurrence.</p> </list-item> </list> </p> </sec> <sec id="bju12369-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12369-list-0003" list-type="bullet"> <list-item> <p>Overall, 185 patients died from their disease; the median survival was 9 months. The survival rates at 1 year were 53, 33, and 39% for patients with no (n = 18), one (n = 109) and two (n = 115) risk factors, respectively, with no significant difference between the groups.</p> </list-item> <list-item> <p>In univariable analyses, higher pT‐stage, tumour necrosis, non‐administered salvage chemotherapy, higher ACCI score, higher ASA score, lower albumin level and higher white blood cell count were significantly associated with a shorter time to cancer‐specific mortality.</p> </list-item> </list> </p> </sec> <sec id="bju12369-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12369-list-0004" list-type="bullet"> <list-item> <p>We confirmed the poor yet variable outcomes of patients with disease recurrence after RNU.</p> </list-item> <list-item> <p>While the Bajorin criteria seem to have limited prognostic value in this specific cohort, we found several other clinical variables to be associated with worse cancer‐specific mortality.</p> </list-item> <list-item> <p>If validated, these factors should be taken into consideration for clinical trial design.</p> </list-item> </list> </p> </sec> </abstract>