Ureteral and Multifocal Tumours Have Worse Prognosis than Renal Pelvic Tumours in Urothelial Carcinoma of the Upper Urinary Tract Treated by Nephroureterectomy

BackgroundIt is not known whether the primary tumour location of upper urinary tract urothelial carcinoma (UUT-UC) is associated with prognosis.ObjectiveTo evaluate the impact of initial primary tumour location on survival in patients who had undergone radical nephroureterectomy (RNU).Design, setting, and participantsUsing a multi-institutional, retrospective database, we identified 609 patients with UUT-UC who had undergone RNU between 1995 and 2010. Tumour location was categorised as renal pelvis, ureter, or multifocal.InterventionAll patients had undergone RNU.MeasurementsTumour location was tested as a prognostic factor for survival through univariate and multivariable Cox regression analysis.Results and limitationsTumour location was renal pelvis in 317 cases (52%), ureter in 185 cases (30%), and multifocal in 107 cases (18%). Compared to renal pelvic and ureteral tumours, multifocal tumours were more likely to be associated with advanced stages (pT3/pT4; 39%, 30%, and 54%, respectively; p < 0.001) and high-grade disease (53%, 56%, and 76%, respectively; p < 0.001). On multivariable analysis, tumour location was an independent prognostic factor for cancer-specific death, disease recurrence, and metastasis (p < 0.05). The 5-yr cancer-specific death–free survival probability was 86.8% for renal pelvic tumours, 68.9% for ureteral tumours, and 56.8% for multifocal tumours (p < 0.001). The retrospective design of this study was its main limitation.ConclusionsUreteral and multifocal tumours had a worse prognosis than renal pelvic tumours. These findings are not in line with recently published data and should be investigated in a prospective assessment to obtain a definitive statement regarding this matter.