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Contemporary conditional cancer‐specific survival after radical nephroureterectomy in patients with nonmetastatic urothelial carcinoma of upper urinary tract
Author(s) -
Rosiello Giuseppe,
Palumbo Carlotta,
Knipper Sophie,
Pecoraro Angela,
Luzzago Stefano,
Deuker Marina,
Mistretta Francesco A.,
Tian Zhe,
Fossati Nicola,
Gallina Andrea,
Montorsi Francesco,
Shariat Shahrokh F.,
Saad Fred,
Briganti Alberto,
Karakiewicz Pierre I.
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25877
Subject(s) - medicine , hazard ratio , proportional hazards model , urology , cancer , cohort , upper urinary tract , urothelial carcinoma , oncology , gastroenterology , urinary system , confidence interval , bladder cancer
Abstract Background and Objectives To examine the effect of conditional survival on 5‐year cancer‐specific survival (CSS) probability after radical nephroureterectomy (RNU) in a contemporary cohort of patients with non‐metastatic urothelial carcinoma of the upper urinary tract (UTUC). Methods Within the Surveillance, Epidemiology and End Results database (2004‐2015), 6826 patients were identified. Conditional 5‐year CSS estimates were assessed after event‐free follow‐up duration. Multivariable Cox regression (MCR) models predicted cancer‐specific mortality (CSM) according to event‐free follow‐up length. Results Overall, 956 (14.0%) were T 1 low grade(LG)N 0 , 1305 (19.1%) T 1 high grade(HG)N 0 , 1215 (17.8%) T 2 N 0 , 2249 (32.9%) T 3 N 0 and 1101 (16.1%) T 4 N 0 /T any N 1‐3 . From baseline, 93.4% to 94.2% in T 1 LGN 0 provided 5‐year CSS and, respectively, 86.2% to 95.3% in T 1 HGN 0 , 77.5% to 87.8% in T 2 N 0 , 63.0% to 91.1% in T 3 N 0 , and 38.8% to 88.2% in T 4 N 0 /T any N 1‐3 . In MCR models, relative to T 1 LGN 0 , T 1 HGN 0 (Hazard ratio [HR] 1.7), T 2 N 0 (HR 3.0), T 3 N 0 (HR: 5.2), and T 4 N 0 /T any N 1‐3 (HR 11.9) were independent predictors of higher CSM. Conditional HRs decreased to levels equivalent to T 1 LGN 0 at 3 years vs 5 years of event‐free survival for T 1 HGN 0 and all other groups, respectively. Conclusions A direct relationship exists between event‐free follow‐up and survival probability after RNU. From a clinical perspective, such survival estimates may have particular importance during preoperative counseling.