Ureteral Involvement Is Associated with Poor Prognosis in Upper Urinary Tract Urothelial Carcinoma Patients Treated by Nephroureterectomy: A Multicenter Database Study

Abstract Background The prognostic significance of tumor location for patients with upper urinary tract urothelial carcinoma (UUT-UC) has been disputed. Several papers have reported that ureteral cancer is associated with worse prognosis. Objective To investigate the prognostic significance of the presence of ureteral tumors in UUT-UC patients who underwent radical nephroureterectomy (RNU). Design, setting, and participants In this multicenter retrospective study, 1068 eligible patients (median follow-up: 40 mo [interquartile range: 17–77 mo]) were divided into three groups based on tumor location: renal pelvic, ureteral, and both–regional (having both renal pelvic and ureteral tumors). The ureteral and both–regional groups were subsequently integrated into the ureteral involvement group to evaluate its prognostic impact. Intervention All patients underwent RNU. Outcome measurements and statistical analysis The prognostic impact of tumor location on survival was analyzed. Results and limitations The renal pelvic, ureteral, and both–regional groups consisted of 507 (47.5%), 430 (40.3%), and 131 (12.3%) patients, respectively. The ureteral and both–regional groups had a higher rate of lymphovascular invasion and lymph node metastasis compared with the renal pelvic group. The renal pelvic and both–regional tumors presented more frequently with locally advanced stages (pT3/T4) compared with the ureteral tumors. The 5-yr cancer-specific survival (CSS) and progression-free survival (PFS) rates of patients in the ureteral (70.5% and 66.7%, respectively) and both–regional groups (64.8% and 57.8%, respectively) were significantly worse than those in the renal pelvic group (81.9% and 78.1%, respectively). In a multivariate analysis, the presence of ureteral involvement was a significant prognostic factor for CSS (hazard ratio [HR]: 1.50; p =0.006) and PFS (HR: 1.35; p =0.023). This study is inherently limited by the biases associated with its retrospective and multicenter design. Conclusions The presence of ureteral involvement had a significant impact on the survival of surgically treated UUT-UC patients associated with a poor prognosis. Patient summary We demonstrated that the ureteral involvement was associated with poor survival compared with patients with renal pelvic tumor only in upper urinary tract urothelial patients treated by nephroureterectomy.