Impact of surgical wait time on oncologic outcomes in upper urinary tract urothelial carcinoma: Surgical Timing of Upper Urinary Tract Urothelial Carcinoma

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Abstract

<p class="first" id="d3534124e87">To assess the effect of surgical wait time on the oncologic outcomes of patients with upper urinary tract urothelial carcinoma (UTUC), particularly in the ureter. </p>

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Most cited references 15

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Upper tract urothelial neoplasms: incidence and survival during the last 2 decades.

J. J. Rubio Muñoz, L Ellison (2000)

Upper tract urothelial cancer is rare but studies in the 1970s showed that its incidence was increasing. We evaluated national trends of the incidence and survival of upper tract urothelial neoplasms from 1973 to 1996. We obtained information on upper tract urothelial neoplasms from 1973 to 1996 from the National Cancer Institute Surveillance, Epidemiology and End Results program. To provide a time comparison we evaluated upper tract urothelial cancer from 1973 to 1984 and 1985 to 1996. We also calculated overall disease specific survival stratified by cancer stage, patient race and gender for the study period overall. A total of 9,072 cases of upper tract urothelial cancer were identified in the Surveillance, Epidemiology and End Results program from 1973 to 1996, including 5,379 of the renal pelvis and 3,678 of the ureter. Comparing age adjusted annual incidence rates revealed an increase in ureteral neoplasms from 0.69 to 0.73/100,000 person-years but no change in the incidence of renal pelvic tumors, while the rate of in situ neoplasms increased from 7. 2% to 23.1%. Overall disease specific 5-year survival was significantly different in regard to tumor stage (95.1% in situ, 88. 9% localized, 62.6% regional and 16.5% distant lesions). Disease specific annual mortality was greater in black than in white individuals and in women than in men (7.4% versus 4.9% and 6.1% versus 4.4%, respectively). There appears to have been a slight increase in the national incidence of ureteral tumors in the last 23 years. Fortunately we also detected a slight improvement in the overall disease specific survival of patients with upper tract neoplasms.

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Mortality increases when radical cystectomy is delayed more than 12 weeks: results from a Surveillance, Epidemiology, and End Results-Medicare analysis.

S Saigal, Claude M Setodji, … (2009)

Single-institution series have documented the adverse impact of a 12-week delay between resection of muscle-invasive bladder cancer and radical cystectomy. These data are derived from tertiary centers, in which referral populations may confound outcomes. The authors sought to examine the survival impact of a delay in radical cystectomy using nationally representative data. From the linked Surveillance, Epidemiology, and End Results-Medicare dataset, the authors identified subjects with stage II transitional cell carcinoma (TCC) of the bladder who underwent radical cystectomy between 1992 and 2001. They examined delays of 8, 12, and 24 weeks and incorporated these delay cutoffs into multivariate Cox proportional hazards survival models. Covariates included age, race/ethnicity, marital status, Charlson comorbidity index, and cancer grade. The authors identified 441 subjects with stage II TCC who underwent cystectomy during the study period. Compared with immediate surgery (ie, within 4-8 weeks of transurethral resection), longer time to cystectomy increased the risk of both disease-specific and overall mortality (hazard ratio [HR], 2.0; P or=3 vs Charlson 0-1; P < .01). Delay in definitive surgical treatment beyond 12 weeks conferred an increased risk of disease-specific and all-cause mortality among subjects with stage II bladder cancer. (c) 2009 American Cancer Society.

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Ureteral and multifocal tumours have worse prognosis than renal pelvic tumours in urothelial carcinoma of the upper urinary tract treated by nephroureterectomy.

Gilles Karsenty, Pierre Colin, Géraldine Pignot … (2011)

It is not known whether the primary tumour location of upper urinary tract urothelial carcinoma (UUT-UC) is associated with prognosis. To evaluate the impact of initial primary tumour location on survival in patients who had undergone radical nephroureterectomy (RNU). Using a multi-institutional, retrospective database, we identified 609 patients with UUT-UC who had undergone RNU between 1995 and 2010. Tumour location was categorised as renal pelvis, ureter, or multifocal. All patients had undergone RNU. Tumour location was tested as a prognostic factor for survival through univariate and multivariable Cox regression analysis. Tumour location was renal pelvis in 317 cases (52%), ureter in 185 cases (30%), and multifocal in 107 cases (18%). Compared to renal pelvic and ureteral tumours, multifocal tumours were more likely to be associated with advanced stages (pT3/pT4; 39%, 30%, and 54%, respectively; p<0.001) and high-grade disease (53%, 56%, and 76%, respectively; p<0.001). On multivariable analysis, tumour location was an independent prognostic factor for cancer-specific death, disease recurrence, and metastasis (p<0.05). The 5-yr cancer-specific death-free survival probability was 86.8% for renal pelvic tumours, 68.9% for ureteral tumours, and 56.8% for multifocal tumours (p<0.001). The retrospective design of this study was its main limitation. Ureteral and multifocal tumours had a worse prognosis than renal pelvic tumours. These findings are not in line with recently published data and should be investigated in a prospective assessment to obtain a definitive statement regarding this matter. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.