Abstract
Background
Upper tract urothelial carcinomas (UTUCs) are increasingly recognized as separate
malignancies. Additional insight into clinical outcomes and key prognostic factors
are needed.
Objectives
To detail outcomes of patients with UTUCs recurring after radical nephroureterectomy
(RNU) and to determine a risk score that predicts outcomes of patients with non–lymph
node distant metastasis.
Design, Setting, and Participants
Chart review of all patients who had an extraurothelial recurrence after RNU for UTUC
at Dana-Farber Cancer Institute between 2009 and 2014.
Outcome Measurements and Statistical Analysis
Median overall survival defined as time from chemotherapy for distant relapse to death.
Prognostic relevance of performance status, hemoglobin, and receipt of cisplatin were
assessed by Cox regression model.
Results and Limitations
A total of 102 patients were identified, 57 of whom had non–lymph node distant metastases
at relapse; 45 received chemotherapy. Median follow-up was 29.8 months; median overall
survival was 14.7 months. Objective response rate to any chemotherapy in the first-line
setting was only 22%. Hemoglobin > 11 g/dL and receipt of cisplatin was associated
with numerically longer median survival but did not reach statistical significance
in univariate and multivariate analysis. Prognostic risk score scale including hemoglobin <
11 g/dL and receipt of cisplatin was inversely associated with survival, with scores
of 0, 1, and 2 leading to median survival of 19.0, 14.9, and 7.2 months (P = .38), respectively.
Conclusions
Advanced UTUC portends a poor prognosis, and most patients cannot receive cisplatin-based
chemotherapy. A risk score that includes anemia and receipt of cisplatin helps stratify
patients with distant metastasis for inclusion into eventual clinical trials. More
studies are needed to validate these findings.
Patient Summary
Metastatic UTUC is an aggressive disease, where anemia and ineligibility to receive
cisplatin are adverse features associated with shorter survival.
Keywords
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Article info
Publication history
Published online: August 01, 2017
Accepted:
July 21,
2017
Received in revised form:
June 24,
2017
Received:
May 11,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
