Radical nephroureterectomy for pathologic T4 upper tract urothelial cancer: Can oncologic outcomes be improved with multimodality therapy?

Ramy F. Youssef, Yair Lotan, Arthur I. Sagalowsky, Shahrokh F. Shariat, Christopher G. Wood, Jay D. Raman, Cord Langner, Richard Zigeuner, Marco Roscigno, Francesco Montorsi, Christian Bolenz, Wassim Kassouf, Vitaly Margulis

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Abstract

Purpose: To report the outcomes of patients with pathologic T4 UTUC and investigate the potential impact of peri-operative chemotherapy combined with radical nephroureterectomy (RNU) and regional lymph node dissection (LND) on oncologic outcomes. Materials and Methods: Patients with pathologic T4 UTUC were identified from the cohort of 1464 patients treated with RNU at 13 academic centers between 1987 and 2007. Oncologic outcomes were stratified according to utilization of perioperative systemic chemotherapy and regional LND as an adjunct to RNU. Results: The study included 69 patients, 42 males (61%) with median age 73 (range 43-98). Median follow-up was 17 months (range: 6-88). Lymphovascular invasion was found in 47 (68%) and regional lymph node metastases were found in 31 (45%). Peri- -operative chemotherapy was utilized in 29 (42%) patients. Patients treated with peri- -operative chemotherapy and RNU with LND demonstrated superior oncologic outcomes compared to those not treated by chemotherapy and/or LND during RNU (3Y-DFS: 35% vs. 10%; P = 0.02 and 3Y-CSS: 28% vs. 14%; P = 0.08). In multivariate Cox regression analysis, administration of peri-operative chemotherapy and utilization of LND during RNU was associated with lower probability of recurrence (HR: 0.4, P = 0.01), and cancer specific mortality (HR: 0.5, P = 0.06). Conclusions: Pathological T4 UTUC is associated with poor prognosis. Peri-operative chemotherapy combined with aggressive surgery, including lymph node dissection, may improve oncological outcomes. Our findings support the use of aggressive multimodal treatment in patients with advanced UTUC.

Original languageEnglish (US)
Pages (from-to)614-621
Number of pages8
JournalInternational Braz J Urol
Volume39
Issue number5
DOIs
StatePublished - Sep 1 2013

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Lymph Node Excision
Drug Therapy
Neoplasms
Therapeutics
Combined Modality Therapy
Lymph Nodes
Regression Analysis
Neoplasm Metastasis
Recurrence
Mortality

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Youssef, Ramy F. ; Lotan, Yair ; Sagalowsky, Arthur I. ; Shariat, Shahrokh F. ; Wood, Christopher G. ; Raman, Jay D. ; Langner, Cord ; Zigeuner, Richard ; Roscigno, Marco ; Montorsi, Francesco ; Bolenz, Christian ; Kassouf, Wassim ; Margulis, Vitaly. / Radical nephroureterectomy for pathologic T4 upper tract urothelial cancer : Can oncologic outcomes be improved with multimodality therapy?. In: International Braz J Urol. 2013 ; Vol. 39, No. 5. pp. 614-621.
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title = "Radical nephroureterectomy for pathologic T4 upper tract urothelial cancer: Can oncologic outcomes be improved with multimodality therapy?",
abstract = "Purpose: To report the outcomes of patients with pathologic T4 UTUC and investigate the potential impact of peri-operative chemotherapy combined with radical nephroureterectomy (RNU) and regional lymph node dissection (LND) on oncologic outcomes. Materials and Methods: Patients with pathologic T4 UTUC were identified from the cohort of 1464 patients treated with RNU at 13 academic centers between 1987 and 2007. Oncologic outcomes were stratified according to utilization of perioperative systemic chemotherapy and regional LND as an adjunct to RNU. Results: The study included 69 patients, 42 males (61{\%}) with median age 73 (range 43-98). Median follow-up was 17 months (range: 6-88). Lymphovascular invasion was found in 47 (68{\%}) and regional lymph node metastases were found in 31 (45{\%}). Peri- -operative chemotherapy was utilized in 29 (42{\%}) patients. Patients treated with peri- -operative chemotherapy and RNU with LND demonstrated superior oncologic outcomes compared to those not treated by chemotherapy and/or LND during RNU (3Y-DFS: 35{\%} vs. 10{\%}; P = 0.02 and 3Y-CSS: 28{\%} vs. 14{\%}; P = 0.08). In multivariate Cox regression analysis, administration of peri-operative chemotherapy and utilization of LND during RNU was associated with lower probability of recurrence (HR: 0.4, P = 0.01), and cancer specific mortality (HR: 0.5, P = 0.06). Conclusions: Pathological T4 UTUC is associated with poor prognosis. Peri-operative chemotherapy combined with aggressive surgery, including lymph node dissection, may improve oncological outcomes. Our findings support the use of aggressive multimodal treatment in patients with advanced UTUC.",
author = "Youssef, {Ramy F.} and Yair Lotan and Sagalowsky, {Arthur I.} and Shariat, {Shahrokh F.} and Wood, {Christopher G.} and Raman, {Jay D.} and Cord Langner and Richard Zigeuner and Marco Roscigno and Francesco Montorsi and Christian Bolenz and Wassim Kassouf and Vitaly Margulis",
year = "2013",
month = "9",
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doi = "10.1590/S1677-5538.IBJU.2013.05.02",
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Youssef, RF, Lotan, Y, Sagalowsky, AI, Shariat, SF, Wood, CG, Raman, JD, Langner, C, Zigeuner, R, Roscigno, M, Montorsi, F, Bolenz, C, Kassouf, W & Margulis, V 2013, 'Radical nephroureterectomy for pathologic T4 upper tract urothelial cancer: Can oncologic outcomes be improved with multimodality therapy?', International Braz J Urol, vol. 39, no. 5, pp. 614-621. https://doi.org/10.1590/S1677-5538.IBJU.2013.05.02

Radical nephroureterectomy for pathologic T4 upper tract urothelial cancer : Can oncologic outcomes be improved with multimodality therapy? / Youssef, Ramy F.; Lotan, Yair; Sagalowsky, Arthur I.; Shariat, Shahrokh F.; Wood, Christopher G.; Raman, Jay D.; Langner, Cord; Zigeuner, Richard; Roscigno, Marco; Montorsi, Francesco; Bolenz, Christian; Kassouf, Wassim; Margulis, Vitaly.

In: International Braz J Urol, Vol. 39, No. 5, 01.09.2013, p. 614-621.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radical nephroureterectomy for pathologic T4 upper tract urothelial cancer

T2 - Can oncologic outcomes be improved with multimodality therapy?

AU - Youssef, Ramy F.

AU - Lotan, Yair

AU - Sagalowsky, Arthur I.

AU - Shariat, Shahrokh F.

AU - Wood, Christopher G.

AU - Raman, Jay D.

AU - Langner, Cord

AU - Zigeuner, Richard

AU - Roscigno, Marco

AU - Montorsi, Francesco

AU - Bolenz, Christian

AU - Kassouf, Wassim

AU - Margulis, Vitaly

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Purpose: To report the outcomes of patients with pathologic T4 UTUC and investigate the potential impact of peri-operative chemotherapy combined with radical nephroureterectomy (RNU) and regional lymph node dissection (LND) on oncologic outcomes. Materials and Methods: Patients with pathologic T4 UTUC were identified from the cohort of 1464 patients treated with RNU at 13 academic centers between 1987 and 2007. Oncologic outcomes were stratified according to utilization of perioperative systemic chemotherapy and regional LND as an adjunct to RNU. Results: The study included 69 patients, 42 males (61%) with median age 73 (range 43-98). Median follow-up was 17 months (range: 6-88). Lymphovascular invasion was found in 47 (68%) and regional lymph node metastases were found in 31 (45%). Peri- -operative chemotherapy was utilized in 29 (42%) patients. Patients treated with peri- -operative chemotherapy and RNU with LND demonstrated superior oncologic outcomes compared to those not treated by chemotherapy and/or LND during RNU (3Y-DFS: 35% vs. 10%; P = 0.02 and 3Y-CSS: 28% vs. 14%; P = 0.08). In multivariate Cox regression analysis, administration of peri-operative chemotherapy and utilization of LND during RNU was associated with lower probability of recurrence (HR: 0.4, P = 0.01), and cancer specific mortality (HR: 0.5, P = 0.06). Conclusions: Pathological T4 UTUC is associated with poor prognosis. Peri-operative chemotherapy combined with aggressive surgery, including lymph node dissection, may improve oncological outcomes. Our findings support the use of aggressive multimodal treatment in patients with advanced UTUC.

AB - Purpose: To report the outcomes of patients with pathologic T4 UTUC and investigate the potential impact of peri-operative chemotherapy combined with radical nephroureterectomy (RNU) and regional lymph node dissection (LND) on oncologic outcomes. Materials and Methods: Patients with pathologic T4 UTUC were identified from the cohort of 1464 patients treated with RNU at 13 academic centers between 1987 and 2007. Oncologic outcomes were stratified according to utilization of perioperative systemic chemotherapy and regional LND as an adjunct to RNU. Results: The study included 69 patients, 42 males (61%) with median age 73 (range 43-98). Median follow-up was 17 months (range: 6-88). Lymphovascular invasion was found in 47 (68%) and regional lymph node metastases were found in 31 (45%). Peri- -operative chemotherapy was utilized in 29 (42%) patients. Patients treated with peri- -operative chemotherapy and RNU with LND demonstrated superior oncologic outcomes compared to those not treated by chemotherapy and/or LND during RNU (3Y-DFS: 35% vs. 10%; P = 0.02 and 3Y-CSS: 28% vs. 14%; P = 0.08). In multivariate Cox regression analysis, administration of peri-operative chemotherapy and utilization of LND during RNU was associated with lower probability of recurrence (HR: 0.4, P = 0.01), and cancer specific mortality (HR: 0.5, P = 0.06). Conclusions: Pathological T4 UTUC is associated with poor prognosis. Peri-operative chemotherapy combined with aggressive surgery, including lymph node dissection, may improve oncological outcomes. Our findings support the use of aggressive multimodal treatment in patients with advanced UTUC.

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U2 - 10.1590/S1677-5538.IBJU.2013.05.02

DO - 10.1590/S1677-5538.IBJU.2013.05.02

M3 - Article

C2 - 24267122

AN - SCOPUS:84891639166

VL - 39

SP - 614

EP - 621

JO - International braz j urol : official journal of the Brazilian Society of Urology

JF - International braz j urol : official journal of the Brazilian Society of Urology

SN - 1677-5538

IS - 5

ER -