High rates of advanced disease, complications, and decline of renal function after radical nephroureterectomy

Abstract: Objectives: Recurrences remain common following radical nephroureterectomy (RNU) for locally advanced upper-tract urothelial carcinoma (UTUC). We review a cohort of RNU patients to identify the incidence of locally advanced disease, decline in renal function, complications, and utilization of adjuvant chemotherapy (AC).Methods: Institutional databases from 7 academic medical centers identified 414 RNU patients treated between 2003 and 2012 who had not received neoadjuvant chemotherapy. Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease equation. Complications were classified according to the modified Clavien system. Cox proportional hazard modeling and Kaplan-Meier analysis determined factors associated with cancer-specific survival.Results: Of 414 patients, 177 (43%) had locally advanced disease, including 118 pT3N0/Nx, 13 pT4N0/Nx, and 46 pTanyN+. Estimated 3- and 5-year cancer-specific survival was 47% and 34%, respectively. Only 31% of patients with locally advanced UTUC received AC. Mean estimated glomerular filtration rate declined from 59 to 51ml/min/1.73m2 following RNU, including a new-onset decline below 60 and 45ml/min/1.73m2 in 25% and 15% of patients, respectively (P
Source: Urologic Oncology: Seminars and Original Investigations - Category: Urology & Nephrology Authors: Tags: Abstracts for Online Original Articles and Reviews Source Type: research