MP27-15 TUMOR LOCATION AS A PREDICTOR OF SURVIVAL FOLLOWING NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CANCER: A U.S. POPULATION BASED ANALYSIS (2004-2012) (2016)

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II1 Apr 2016MP27-15 TUMOR LOCATION AS A PREDICTOR OF SURVIVAL FOLLOWING NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CANCER: A U.S. POPULATION BASED ANALYSIS (2004-2012) Meera Chappidi, Max Kates, Trinity Bivalacqua, and Phillip Pierorazio Meera ChappidiMeera Chappidi More articles by this author , Max KatesMax Kates More articles by this author , Trinity BivalacquaTrinity Bivalacqua More articles by this author , and Phillip PierorazioPhillip Pierorazio More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1046AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is no consensus regarding the prognostic importance of tumor location in patients with upper tract urothelial carcinoma (UTUC) undergoing nephroureterectomy (NU). Biologically plausible mechanisms for worse cancer specific survival (CSS) have been proposed for both renal pelvis (RP) tumors and ureteral tumors. We sought to determine the impact of tumor location on overall survival (OS) and CSS in UTUC patients undergoing NU in a large US population from 2004 onwards. METHODS The Surveillance, Epidemiology, and End Results (SEER) registry was queried for patients undergoing NU for UTUC at 17 sites from 2004-2012. Patients without histologic diagnosis, tumor grade, pathologic stage (T, N, or M), or diagnosis on autopsy were excluded. Patients were classified as having primary RP tumors or primary ureteral tumors. The primary endpoint was OS with a secondary endpoint of CSS. Covariates of interest were age, sex, race, registry site, year of surgery (2004-06 vs. 2007-09 vs. 2010-12), tumor grade, tumor size, and AJCC 6th edition TMN stages. RESULTS Of the 5691 patients identified, 3673 (64.5%) had RP tumors and 2018 (35.5%) had ureteral tumors. Patients with RP vs. ureteral tumors were younger [71.0 vs. 72.1, p<0.001] and more likely to have advanced stage (pT3/4) disease [36.6% vs. 28.0%, p<0.001]. There was no difference in N or M stage, sex, race, tumor grade, tumor size, or mean follow-up time based on tumor location. With a median follow-up time of 32 months, 5-year OS was higher for RP tumors [56.8%; 95% confidence interval (CI) 54.8%-58.8%] than ureteral tumors [51.2%; CI 48.5%-53.9%; p=0.1]. In a multivariate model controlling for age, sex, race, tumor grade, registry site, year of surgery, and TMN pathologic stage, ureteral tumors were associated with significantly worse OS [HR=1.14; CI 1.04-1.25]. The 5-year CSS was comparable for RP [85.5%; CI 84.0%-86.9%] and ureteral [86.0%; CI 83.9%-87.8%; p=0.3] tumors. In a multivariate model controlling for previously mentioned covariates, tumor location [HR=0.97; CI 0.81-1.15] was not a predictor of CSS while older age, grade 3/4, T, N, and M stage were predictors. CONCLUSIONS While patients with ureteral tumors are more likely to present with lower stage disease, they have worse OS following NU compared to patients with RP tumors. Since CSS is comparable between the two groups, the disparity in OS based on tumor location is most likely not due to a difference in tumor biology. Further studies are warranted to better understand the worse OS in ureteral tumor patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e368 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Meera Chappidi More articles by this author Max Kates More articles by this author Trinity Bivalacqua More articles by this author Phillip Pierorazio More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...