Predictors of survival in patients with upper tract urothelial carcinoma after surgical treatment

Background. Upper tract urothelial carcinoma (UTUC) accounts for only 5–10 % of all urothelial cancer sites. Radical nephroureterectomy is the main treatment method in patients without distant metastases.

Aim. To study survival and assess the impact of preand postoperative clinical and pathomorphological factors on the risk of death in patients with UTUC after surgical treatment.

Materials and methods. The results of surgical treatment of 157 patients with UTUC over a ten-year period were analyzed. Radical nephroureterectomy was performed in 151 (96.1 %) patients. Organ-preserving treatment was used in 6 (5.9 %) cases. Smoking was registered in 64 (40.8 %) patients. Obesity was observed in 40 (36.4 %) of 110 (70.1 %) patients available for analysis. Overall (OS), cancer-specific (CSS), progression-free (PFS), and recurrence-free survival rates were estimated. Univariate and multivariate Cox regression analysis was used to assess the impact of clinical and pathomorphological factors on the risk of patient death.

Results. The 5-year OS, CSS, and PFS were 67.9, 76.5, and 74.2 %, respectively. The 5-year recurrence-free survival was 73.4 %. The 5-year OS in the obese group was 72.7 % versus 56.5 % in the non-obese group (p = 0.042). In obese patients, there was statistically significant predominance of women (p = 0.001), significantly lower proportion of patients with regional lymph node involvement (p = 0.041), and a significantly lower number of smoking patients (p = 0.049). According to multivariate regression analysis, the risk of death was significantly increased in patients with Charlson comorbidity index above 5 (hazard ratio (HR) 2.34; 95 % confidence interval (CI) 1.33–4.11; p <0.001) and regional lymph node involvement (HR 2.78; 95 % CI 1.36–5.70; p <0.001). Multivariate analysis showed that development of non-muscle invasive recurrence in the bladder decreased the risk of death after surgical treatment (HR 0.23; 95 % CI 0.08–0.61; p = 0.003).

Conclusion. Such factors as advancement of the primary tumor and initial somatic status of the patient have negative impact on the risk of patient death after surgical treatment of UTUC. Patients with obesity have better OS, CSS, PFS, are significantly more often female, significantly rarer have regional lymph node involvement and smoke. Development of non-muscle invasive recurrence in the bladder significantly reduces the risk of patient death.