Contemporary conditional cancer‐specific survival after radical nephroureterectomy in patients with nonmetastatic urothelial carcinoma of upper urinary tract
Giuseppe Rosiello, Carlotta Palumbo, Sophie Knipper, Angela Pecoraro, Stefano Luzzago, Marina Deuker, Francesco Alessandro Mistretta, Zhe Tian, Nicola Fossati, Andrea Gallina, Francesco Montorsi, Shahrokh F. Shariat, Fred Saad, Alberto Briganti, Pierre I. Karakiewicz
Abstract
Abstract Background and Objectives To examine the effect of conditional survival on 5‐year cancer‐specific survival (CSS) probability after radical nephroureterectomy (RNU) in a contemporary cohort of patients with non‐metastatic urothelial carcinoma of the upper urinary tract (UTUC). Methods Within the Surveillance, Epidemiology and End Results database (2004‐2015), 6826 patients were identified. Conditional 5‐year CSS estimates were assessed after event‐free follow‐up duration. Multivariable Cox regression (MCR) models predicted cancer‐specific mortality (CSM) according to event‐free follow‐up length. Results Overall, 956 (14.0%) were T 1 low grade(LG)N 0 , 1305 (19.1%) T 1 high grade(HG)N 0 , 1215 (17.8%) T 2 N 0 , 2249 (32.9%) T 3 N 0 and 1101 (16.1%) T 4 N 0 /T any N 1‐3 . From baseline, 93.4% to 94.2% in T 1 LGN 0 provided 5‐year CSS and, respectively, 86.2% to 95.3% in T 1 HGN 0 , 77.5% to 87.8% in T 2 N 0 , 63.0% to 91.1% in T 3 N 0 , and 38.8% to 88.2% in T 4 N 0 /T any N 1‐3 . In MCR models, relative to T 1 LGN 0 , T 1 HGN 0 (Hazard ratio [HR] 1.7), T 2 N 0 (HR 3.0), T 3 N 0 (HR: 5.2), and T 4 N 0 /T any N 1‐3 (HR 11.9) were independent predictors of higher CSM. Conditional HRs decreased to levels equivalent to T 1 LGN 0 at 3 years vs 5 years of event‐free survival for T 1 HGN 0 and all other groups, respectively. Conclusions A direct relationship exists between event‐free follow‐up and survival probability after RNU. From a clinical perspective, such survival estimates may have particular importance during preoperative counseling.