High rates of advanced disease, complications, and decline of renal function after radical nephroureterectomy

Jay Raman, Yu Kuan Lin, Matthew G. Kaag, Timothy Atkinson, Paul Crispen, Mark Wille, Norm Smith, Mark Hockenberry, Thomas Guzzo, Benoit Peyronnet, Karim Bensalah, Jay Simhan, Alexander Kutikov, Eugene Cha, Michael Herman, Douglas Scherr, Shahrokh F. Shariat, Stephen A. Boorjian

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objectives: Recurrences remain common following radical nephroureterectomy (RNU) for locally advanced upper-tract urothelial carcinoma (UTUC). We review a cohort of RNU patients to identify the incidence of locally advanced disease, decline in renal function, complications, and utilization of adjuvant chemotherapy (AC). Methods: Institutional databases from 7 academic medical centers identified 414 RNU patients treated between 2003 and 2012 who had not received neoadjuvant chemotherapy. Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease equation. Complications were classified according to the modified Clavien system. Cox proportional hazard modeling and Kaplan-Meier analysis determined factors associated with cancer-specific survival. Results: Of 414 patients, 177 (43%) had locally advanced disease, including 118 pT3N0/Nx, 13 pT4N0/Nx, and 46 pTanyN+. Estimated 3- and 5-year cancer-specific survival was 47% and 34%, respectively. Only 31% of patients with locally advanced UTUC received AC. Mean estimated glomerular filtration rate declined from 59 to 51ml/min/1.73m2 following RNU, including a new-onset decline below 60 and 45ml/min/1.73m2 in 25% and 15% of patients, respectively (P<0.001 for both). Complications occurred in 46 of 177 (26%) patients, of which one-quarter were grade III or IV. Increasing age (Hazard Ratio (HR) 1.4, P = 0.03), positive surgical margins (HR 2.1, P = 0.01), and positive lymph nodes (HR 4.3, P<0.001) were associated with an increased risk of death from UTUC, whereas receipt of AC (HR 0.85, P = 0.05) was associated with a decrease in UTUC mortality. Conclusions: Under one-third of RNU patients with locally advanced UTUC cancers received AC. Perioperative complications and decline in renal function may have contributed to this low rate. Such data further underscore the need for continued discussion regarding the use of chemotherapy in a neoadjuvant setting for appropriately selected patients with UTUC.

Original languageEnglish (US)
Pages (from-to)47.e9-47.e14
JournalUrologic Oncology: Seminars and Original Investigations
Volume32
Issue number1
DOIs
StatePublished - Jan 1 2014

Fingerprint

Kidney
Adjuvant Chemotherapy
Carcinoma
Glomerular Filtration Rate
Diet Therapy
Drug Therapy
Survival
Kaplan-Meier Estimate
Neoplasms
Lymph Nodes
Databases
Recurrence
Mortality
Incidence

All Science Journal Classification (ASJC) codes

  • Oncology
  • Urology

Cite this

Raman, Jay ; Lin, Yu Kuan ; Kaag, Matthew G. ; Atkinson, Timothy ; Crispen, Paul ; Wille, Mark ; Smith, Norm ; Hockenberry, Mark ; Guzzo, Thomas ; Peyronnet, Benoit ; Bensalah, Karim ; Simhan, Jay ; Kutikov, Alexander ; Cha, Eugene ; Herman, Michael ; Scherr, Douglas ; Shariat, Shahrokh F. ; Boorjian, Stephen A. / High rates of advanced disease, complications, and decline of renal function after radical nephroureterectomy. In: Urologic Oncology: Seminars and Original Investigations. 2014 ; Vol. 32, No. 1. pp. 47.e9-47.e14.
@article{f904c8914bbf481ca0fcc19d21f710ea,
title = "High rates of advanced disease, complications, and decline of renal function after radical nephroureterectomy",
abstract = "Objectives: Recurrences remain common following radical nephroureterectomy (RNU) for locally advanced upper-tract urothelial carcinoma (UTUC). We review a cohort of RNU patients to identify the incidence of locally advanced disease, decline in renal function, complications, and utilization of adjuvant chemotherapy (AC). Methods: Institutional databases from 7 academic medical centers identified 414 RNU patients treated between 2003 and 2012 who had not received neoadjuvant chemotherapy. Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease equation. Complications were classified according to the modified Clavien system. Cox proportional hazard modeling and Kaplan-Meier analysis determined factors associated with cancer-specific survival. Results: Of 414 patients, 177 (43{\%}) had locally advanced disease, including 118 pT3N0/Nx, 13 pT4N0/Nx, and 46 pTanyN+. Estimated 3- and 5-year cancer-specific survival was 47{\%} and 34{\%}, respectively. Only 31{\%} of patients with locally advanced UTUC received AC. Mean estimated glomerular filtration rate declined from 59 to 51ml/min/1.73m2 following RNU, including a new-onset decline below 60 and 45ml/min/1.73m2 in 25{\%} and 15{\%} of patients, respectively (P<0.001 for both). Complications occurred in 46 of 177 (26{\%}) patients, of which one-quarter were grade III or IV. Increasing age (Hazard Ratio (HR) 1.4, P = 0.03), positive surgical margins (HR 2.1, P = 0.01), and positive lymph nodes (HR 4.3, P<0.001) were associated with an increased risk of death from UTUC, whereas receipt of AC (HR 0.85, P = 0.05) was associated with a decrease in UTUC mortality. Conclusions: Under one-third of RNU patients with locally advanced UTUC cancers received AC. Perioperative complications and decline in renal function may have contributed to this low rate. Such data further underscore the need for continued discussion regarding the use of chemotherapy in a neoadjuvant setting for appropriately selected patients with UTUC.",
author = "Jay Raman and Lin, {Yu Kuan} and Kaag, {Matthew G.} and Timothy Atkinson and Paul Crispen and Mark Wille and Norm Smith and Mark Hockenberry and Thomas Guzzo and Benoit Peyronnet and Karim Bensalah and Jay Simhan and Alexander Kutikov and Eugene Cha and Michael Herman and Douglas Scherr and Shariat, {Shahrokh F.} and Boorjian, {Stephen A.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1016/j.urolonc.2013.06.015",
language = "English (US)",
volume = "32",
pages = "47.e9--47.e14",
journal = "Urologic Oncology",
issn = "1078-1439",
publisher = "Elsevier Inc.",
number = "1",

}

Raman, J, Lin, YK, Kaag, MG, Atkinson, T, Crispen, P, Wille, M, Smith, N, Hockenberry, M, Guzzo, T, Peyronnet, B, Bensalah, K, Simhan, J, Kutikov, A, Cha, E, Herman, M, Scherr, D, Shariat, SF & Boorjian, SA 2014, 'High rates of advanced disease, complications, and decline of renal function after radical nephroureterectomy', Urologic Oncology: Seminars and Original Investigations, vol. 32, no. 1, pp. 47.e9-47.e14. https://doi.org/10.1016/j.urolonc.2013.06.015

High rates of advanced disease, complications, and decline of renal function after radical nephroureterectomy. / Raman, Jay; Lin, Yu Kuan; Kaag, Matthew G.; Atkinson, Timothy; Crispen, Paul; Wille, Mark; Smith, Norm; Hockenberry, Mark; Guzzo, Thomas; Peyronnet, Benoit; Bensalah, Karim; Simhan, Jay; Kutikov, Alexander; Cha, Eugene; Herman, Michael; Scherr, Douglas; Shariat, Shahrokh F.; Boorjian, Stephen A.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 32, No. 1, 01.01.2014, p. 47.e9-47.e14.

Research output: Contribution to journalArticle

TY - JOUR

T1 - High rates of advanced disease, complications, and decline of renal function after radical nephroureterectomy

AU - Raman, Jay

AU - Lin, Yu Kuan

AU - Kaag, Matthew G.

AU - Atkinson, Timothy

AU - Crispen, Paul

AU - Wille, Mark

AU - Smith, Norm

AU - Hockenberry, Mark

AU - Guzzo, Thomas

AU - Peyronnet, Benoit

AU - Bensalah, Karim

AU - Simhan, Jay

AU - Kutikov, Alexander

AU - Cha, Eugene

AU - Herman, Michael

AU - Scherr, Douglas

AU - Shariat, Shahrokh F.

AU - Boorjian, Stephen A.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Objectives: Recurrences remain common following radical nephroureterectomy (RNU) for locally advanced upper-tract urothelial carcinoma (UTUC). We review a cohort of RNU patients to identify the incidence of locally advanced disease, decline in renal function, complications, and utilization of adjuvant chemotherapy (AC). Methods: Institutional databases from 7 academic medical centers identified 414 RNU patients treated between 2003 and 2012 who had not received neoadjuvant chemotherapy. Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease equation. Complications were classified according to the modified Clavien system. Cox proportional hazard modeling and Kaplan-Meier analysis determined factors associated with cancer-specific survival. Results: Of 414 patients, 177 (43%) had locally advanced disease, including 118 pT3N0/Nx, 13 pT4N0/Nx, and 46 pTanyN+. Estimated 3- and 5-year cancer-specific survival was 47% and 34%, respectively. Only 31% of patients with locally advanced UTUC received AC. Mean estimated glomerular filtration rate declined from 59 to 51ml/min/1.73m2 following RNU, including a new-onset decline below 60 and 45ml/min/1.73m2 in 25% and 15% of patients, respectively (P<0.001 for both). Complications occurred in 46 of 177 (26%) patients, of which one-quarter were grade III or IV. Increasing age (Hazard Ratio (HR) 1.4, P = 0.03), positive surgical margins (HR 2.1, P = 0.01), and positive lymph nodes (HR 4.3, P<0.001) were associated with an increased risk of death from UTUC, whereas receipt of AC (HR 0.85, P = 0.05) was associated with a decrease in UTUC mortality. Conclusions: Under one-third of RNU patients with locally advanced UTUC cancers received AC. Perioperative complications and decline in renal function may have contributed to this low rate. Such data further underscore the need for continued discussion regarding the use of chemotherapy in a neoadjuvant setting for appropriately selected patients with UTUC.

AB - Objectives: Recurrences remain common following radical nephroureterectomy (RNU) for locally advanced upper-tract urothelial carcinoma (UTUC). We review a cohort of RNU patients to identify the incidence of locally advanced disease, decline in renal function, complications, and utilization of adjuvant chemotherapy (AC). Methods: Institutional databases from 7 academic medical centers identified 414 RNU patients treated between 2003 and 2012 who had not received neoadjuvant chemotherapy. Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease equation. Complications were classified according to the modified Clavien system. Cox proportional hazard modeling and Kaplan-Meier analysis determined factors associated with cancer-specific survival. Results: Of 414 patients, 177 (43%) had locally advanced disease, including 118 pT3N0/Nx, 13 pT4N0/Nx, and 46 pTanyN+. Estimated 3- and 5-year cancer-specific survival was 47% and 34%, respectively. Only 31% of patients with locally advanced UTUC received AC. Mean estimated glomerular filtration rate declined from 59 to 51ml/min/1.73m2 following RNU, including a new-onset decline below 60 and 45ml/min/1.73m2 in 25% and 15% of patients, respectively (P<0.001 for both). Complications occurred in 46 of 177 (26%) patients, of which one-quarter were grade III or IV. Increasing age (Hazard Ratio (HR) 1.4, P = 0.03), positive surgical margins (HR 2.1, P = 0.01), and positive lymph nodes (HR 4.3, P<0.001) were associated with an increased risk of death from UTUC, whereas receipt of AC (HR 0.85, P = 0.05) was associated with a decrease in UTUC mortality. Conclusions: Under one-third of RNU patients with locally advanced UTUC cancers received AC. Perioperative complications and decline in renal function may have contributed to this low rate. Such data further underscore the need for continued discussion regarding the use of chemotherapy in a neoadjuvant setting for appropriately selected patients with UTUC.

UR - http://www.scopus.com/inward/record.url?scp=84890792345&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84890792345&partnerID=8YFLogxK

U2 - 10.1016/j.urolonc.2013.06.015

DO - 10.1016/j.urolonc.2013.06.015

M3 - Article

C2 - 24140248

AN - SCOPUS:84890792345

VL - 32

SP - 47.e9-47.e14

JO - Urologic Oncology

JF - Urologic Oncology

SN - 1078-1439

IS - 1

ER -