Oncological outcomes after radical nephroureterectomy for upper tract urothelial carcinoma: Comparison over the three decades

Objective: To evaluate temporal trends in clinicopathological features and oncological outcomes after radical nephroureterectomy for upper tract urothelial carcinoma. Methods: Utilizing a multi-institutional database of patients treated with radical nephroureterectomy between 1983 and 2007, we compared clinicopathological features and survival outcomes over the past three decades using the following cohorts: group 1 comprised of patients treated before the 1990s (n = 106), group 2 from 1990 to1999 (n = 655), and group 3 from 2000 to 2007 (n = 701). Survival rates were compared using Kaplan-Meier survival analysis. Results: The study included 1462 patients, 992 men and 470 women, with 36 months median follow up (range 1250 months) after radical nephroureterectomy. Tumors were organ confined (=T2/N0) in 88% and high-grade in 64%. Neoadjuvant and adjuvant systemic chemotherapy was administered in 47 (3.2%) and 171 (11.7%) patients, respectively. There was a significant increase in the use of laparoscopic radical nephroureterectomy, endoscopic management of urothelial carcinoma and utilization of perioperative chemotherapy between decades 1 to 3. There were no significant differences in pathological stage distribution. The overall 5-year disease-free survival rates were 66 +/- 5%, 68.5 +/- 2% and 71 +/- 2%, and the 5-year cancer-specific survival rates were 75 +/- 5%, 72 +/- 2%, and 75 +/- 2% for groups 1, 2 and 3, respectively, with no significant statistical differences between the three decades (P > 0.05). Conclusion: Outcomes after radical nephroureterectomy have not changed significantly over the past three decades, despite staging and surgical refinements. Utilization of perioperative systemic chemotherapy in urothelial carcinoma management remains low. Further improvements in outcomes of urothelial carcinoma patients necessitate rigorous investigation of multimodal treatment approaches.