SURVIVAL IS THE SAME FOR RENAL PELVIS AND URETER CANCER OF THE SAME STAGE

NEW YORK (Reuters Health) Jul 29 - Tumor location does not affect prognosis after radical nephroureterectomy for upper-tract urothelial carcinoma, according to a new single-center study.

"People used to think that the patients who have tumors in the ureter do worse than the patients who have tumors in the renal pelvis," lead author Dr. Guido Dalbagni of Memorial Sloan-Kettering Cancer Center in New York City told Reuters Health. However, he added, recent research suggests that once tumor stage is controlled for, outcomes are the same no matter where the primary tumor occurred.

But studies of this issue have been limited by small sample size as well as by variations in surgical approaches, lack of a centralized slide review protocol, and differences in disease severity and management, Dr. Dalbagni and his colleagues say.

To address some of these issues, the researchers analyzed consecutive cases of upper-tract urothelial carcinoma treated with radical nephroureterectomy at Memorial Sloan-Kettering; they hypothesized that tumor location would not affect prognosis.

As they reported online July 26th in European Urology, the researchers analyzed 253 patients; 69% had renal pelvic tumors and 31% had ureteral tumors. Overall, non-bladder recurrence-free five-year survival was 71%, while cancer-specific survival was 78%.

Disease recurred in 60% of the patients. Two- and 5-year recurrence-free survival rates were 42% and 32%, respectively. The median follow-up in survivors was 48 months.

The authors could find no link between tumor location and disease recurrence; the hazard ratio was 1.19 for ureteral tumors compared to renal pelvis tumors, with a p value of 0.32.

Forty-eight patients died from their disease, including 30 with renal pelvic tumors and 18 with ureteral tumors. The 5-year cancer specific survival rate was 78%, with no significant difference based on initial tumor location.

The only factors associated with outcomes after multivariate analysis were pathologic stage and nodal status. The adjusted hazard ratio for non-bladder recurrence for pT3/pT4 tumors vs. non-muscle invasive tumors was 4.75. In patients with positive lymph nodes, the adjusted hazard ratio for non-bladder recurrence was 3.23 compared to patients with no lymph node involvement.

The researchers did find that presentation with hydronephrosis was more common for ureteral tumors, while hematuria was more common with renal pelvic tumors. This difference in presentation is likely why patients with ureteral primary tumors were thought to fare worse, Dr. Dalbagni said.

He noted that hydronephrosis isn't likely to be picked up unless a patient undergoes a scan, meaning the disease may frequently be diagnosed later than when it presents as blood in the urine. However, he added, "if you catch them at the same pathological stage, then they do the same."

Limitations of the study include its retrospective, single-center design. Therefore, Dr. Dalbagni and colleagues say, the results "are subject to the inherent biases associated with high-volume tertiary care centers." They also note that their study included a large proportion of patients with high-grade disease. Its strengths, they add, include the use of centralized pathologic review and standardized follow-up.

They conclude: "Clinical decisions regarding adjuvant therapy or follow-up protocol should not differ between patients with renal pelvic or ureteral upper-tract urothelial carcinoma."

SOURCE: Abstract

European Urology 2010.