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Poor prognosis seen in patients treated with nephroureterectomy after cystectomy

16 Aug 2017

A recent study has shown that patients with panurothelial carcinoma who underwent radical cystectomy and then radical nephroureterectomy with locally advanced disease in a large proportion have poor prognosis.

Researchers identified patients treated with nephroureterectomy following cystectomy for metachronous urothelial recurrence at an institution between January 1995 and December 2014. They used univariable Cox regression to assess the association of overall survival with age, grade, stage, lymph node metastasis and radiographic findings.

Sixty-four out of 3,173 patients treated with cystectomy (median age at surgery, 66 years) underwent subsequent nephroureterectomy for metachronous urothelial recurrence (median time from cystectomy to nephroureterectomy, 2.7 years). A total of 37 patients underwent ureteroscopy prior to nephroureterectomy; of these, 29 (78 percent) had a positive biopsy.

There was locally advanced disease (pT3/pT4) in 39 percent of cases and positive node status in 11 percent on nephroureterectomy pathology findings compared with locally advanced disease in 17 percent and positive node status in 6 percent on cystectomy pathology findings.

The postradical nephroureterectomy estimated glomerular filtration rate was <60 ml/minute/1.73 m2 in 96 percent of patients and <30 ml/minute/1.73 m2 in 40 percent. Median overall survival was 3.1 years (95 percent CI, 2.4 to 4.3) following nephroureterectomy.

Only lymph node involvement at radical nephroureterectomy was significantly associated with worse overall mortality (hazard ratio, 2.73; 1.04 to 7.15; p=0.041).

“The prognosis is poor in patients with panurothelial carcinoma treated with nephroureterectomy following cystectomy with locally advanced disease in a large proportion,” researchers said. “Renal function after these procedures diminished and almost all patients were ineligible for cisplatin-based chemotherapy.”

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