What is the prognosis of urothelial tumors of the renal pelvis and ureters after treatment?

Updated: Aug 07, 2020
  • Author: Kyle A Richards, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

For all patients with upper tract urothelial cancer, the unadjusted 5-year survival rate is approximately 57%. On multivariate analysis, only stage and age were significant prognostic factors for survival. [64]

Gandaglia et al examined the Surveillance, Epidemiology, and End Results (SEER) database of 9899 upper tract urothelial cancer patients undergoing radical nephroureterectomy and determined that cancer-specific mortality was 18.1%, other-cause mortality was 9.1%, and bladder cancer mortality was 31.2%. Both cancer-specific mortality and other-cause mortality increased with age. Although cancer-specific mortality and bladder cancer mortality increased with advancing stage, all-cause mortality remained stable. [65]

A multivariate competing risk regression model showed that besides age and stage, risk factors for higher cancer-specific mortality included the following [65] :

  • Type of surgery
  • Female sex
  • Tumor location
  • Tumor grade

Bladder cancer mortality correlated with ureteral location, stage, and grade. [65]

Reported recurrence rates vary. Rink et al (2012) report an overall recurrence rate of 24% in their study population of 2494 patients treated with radical nephroureterectomy. Approximately 80% of those patients who had recurrence died within 24 months after the recurrence. A shorter time of recurrence to death was related to pT3 and pT4 stages, ureteral tumor location, omission of a lymph node dissection, and shorter time to recurrence. [66]

Biopsy grade is generally accepted as accurate and correlates to pathologic findings. [10] Conversely, owing to the difficulties in obtaining muscle in biopsy specimens and the limitations of imaging, the up-staging rate is 45%. [67]

Advanced age has previously been shown to be related to poor clinical outcomes, including cancer-specific and overall survival. [68] However, a study by Chromecki et al found that a high percentage of elderly patients who underwent radical nephroureterectomy were cured, suggesting that chronological age alone is an unreliable criterion for outcome in older patients. [69]

American Society of Anesthesiologists scores significantly correlate with cancer-specific survival after radical nephroureterectomy. [70]

Active smoking, a smoking history of at least 20 years, and smoking at least 1 cigarette per day is significantly associated with advanced disease, greater recurrence, and worse cancer-specific mortality. Patients who quit smoking more than 10 years ago have better oncologic outcomes. [71]

Tumor location, (ie, renal pelvis versus ureter) is inconsistently reported to affect prognosis, with some articles suggesting a worse prognosis for ureteric location and others showing no difference. [10]

Hydronephrosis predicts advanced pathologic stage, metastasis, and cancer-specific survival. [16, 72, 73]

For patients with a higher body mass index who were treated with radical nephroureterectomy, a study by Ehdaie et al found that overall survival rates were diminished. [74]


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