Clinicopathological Characteristics And Prognosis For Patients With Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy

Purpose: Upper tract urothelial carcinoma(UTUC)is a relatively rare urologic tumor.This study aimed to investigate the clinicopathological characteristics and prognostic features of UTUC patients treated by radical surgery to improve the diagnosis and treatment of UTUC.Patients and methods: The clinical and follow-up data of 802 UTUC patients who underwent radical nephroureterectomy(RNU)from January 1998 to March 2016 were retrospectively analyzed.The clinicopathological characteristics and prognostic factors were studied.Statistical differences between clinical and pathological parameters between groups were assessed using Student's t test and Pearson chi-square test.Survival analysis was performed using Kaplan-Meier method and log-rank test and Cox proportional hazard model was used for univariate and multivariate analysis.A Nomogram prognostic model was established based on independent prognostic factors and internal validation was performed.Results: There were 432 cases(53.9%)of renal pelvic tumors,317 cases(39.5%)of ureteral tumors and 53 cases(6.6%)were located in the renal pelvis and ureter.239 cases(29.8%)were low grade and 563 cases(70.2%)were high grade.95 cases(49.3%)were in Ta-T1 stage,133 cases(16.6%)in T2 stage,252 cases(31.4%)in T3 stage and 22 cases(2.7%)in T4 stage.Lymph node dissection was performed in 168 patients(20.1%)and 48 patients(6.0%)had pathologically confirmed lymph node metastasis.During a median follow-up of 41 months(2-206 months),a total of 267 patients died and 207 died of UTUC.201 had distant metastases and 183 had intravesical recurrence.Multivariate analysis showed age ?65 years(HR = 1.941,1.846;P<0.001,<0.001),previous or synchronous presence of non-muscle invasive bladder cancer(NMIBC)(HR = 1.621,1.787;P=0.003,0.001),high grade tumors(HR=1.607,2.107;P=0.004,<0.001),pathological stage ?p T2(HR=1.457,1.518;P=0.012,0.016),lymph node metastasis(HR=2.258,1.724;P<0.001,=0.024),sessile growth(HR=1.462,1.471;P=0.009,0.021),with squamous or adenoid differentiation(HR=1.806,1.788;P=0.020,0.030),with lymphovascular invasion(LVI)(HR=1.505,1.708;P=0.014,0.003)and positive surgical margin(HR=1.848,1.760;P=0.010,0.033)were independent risk factors for overall survival(OS)and cancer-specific survival(CSS).Without adjuvant chemotherapy(HR=1.905,P=0.001)was an independent risk factor for OS while tumor diameter >3cm(HR=1.337,P=0.048)was an independent risk factor for CSS.Previous or synchronous presence of NMIBC(HR=1.456,2.275;P=0.046,<0.001),high grade tumors(HR=2.075,1.409;P=0.001,0.041)and positive surgical margin(HR=1.747,2.258;P =0.031,0.002)were independent risk factors for metastasis-free survival(MFS)and intravesical recurrence-free survival(IRFS).Age ?65 years(HR = 1.448,P = 0.022),pathological stage ?p T2(HR=2.096,P<0.001),lymph node metastasis(HR=2.444,P<0.001),with LVI(HR=1.543,P=0.021)and without adjuvant chemotherapy after surgery(HR=2.741,P<0.001)was independent risk factors for MFS;Ureteroscopy(HR=1.772,P=0.001),laparoscopic surgery(HR=1.411,P=0.024),tumor diameter >3cm(HR=1.483,P=0.009)were independent risk factors for IRFS.Conclusions: UTUC has a high degree of malignancy and poor prognosis.The Chinese population has different clinicopathological characteristics and prognostic features from the Western population.Age ?65 years,previous or synchronous presence of NMIBC,high grade tumor,pathological stage ?p T2,lymph node metastasis,sessile growth,squamous or adenoid differentiation,with LVI and positive surgical margin are independent risk factors for OS and CSS.Without adjuvant chemotherapy after surgery was an independent risk factor for OS while tumor diameter >3cm was an independent risk factor for CSS.Previous or synchronous presence of NMIBC,high grade tumors and positive surgical margin were independent risk factors for MFS and IRFS.Age ?65 years,pathological stage ?p T2,lymph node metastasis,with LVI and without adjuvant chemotherapy after surgery were independent risk factors for MFS while ureteroscopy,laparoscopic surgery and tumor diameter >3cm were independent risk factors for IRFS.