Does preoperative symptom classification impact prognosis in patients with clinically localized upper-tract urothelial carcinoma managed by radical nephroureterectomy?
Abstract Objectives To evaluate if preoperative symptom classification could refine prediction of outcomes for patients with clinically localized upper-tract urothelial carcinoma (UTUC) managed by radical nephroureterectomy (RNU). Methods Data on 654 patients with localized UTUC who underwent RNU we...
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| Veröffentlicht in: | Urologic oncology 2011-11, Vol.29 (6), p.716-723 |
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| creator | Raman, Jay D., M.D Shariat, Shahrokh F., M.D Karakiewicz, Pierre I., M.D Lotan, Yair, M.D Sagalowsky, Arthur I., M.D Roscigno, Marco, M.D Montorsi, Francesco, M.D Bolenz, Christian, M.D Weizer, Alon Z., M.D Wheat, Jeffery C., M.D Ng, Casey K., M.D Scherr, Douglas S., M.D Remzi, Mesut, M.D Waldert, Matthias, M.D Wood, Christopher G., M.D Margulis, Vitaly, M.D |
| description | Abstract Objectives To evaluate if preoperative symptom classification could refine prediction of outcomes for patients with clinically localized upper-tract urothelial carcinoma (UTUC) managed by radical nephroureterectomy (RNU). Methods Data on 654 patients with localized UTUC who underwent RNU were reviewed. Preoperative symptoms were classified as incidental (S1), local (S2), and systemic (S3). Clinical and pathologic data were compared between the cohorts. Kaplan-Meier analyses and Cox proportional hazard modeling were used to determine recurrence-free and cancer-specific survival amongst the symptom cohorts. Results Symptom classification was S1 in 213 (33%) patients, S2 in 402 (61%), and S3 in 39 (6%). S3 symptoms were associated with advanced pathology, including higher stage, grade, and lymph node (LN) positivity. Five and 10-year recurrence-free and cancer-specific survival estimates were similar for patients with S1 and S2 symptoms ( P = 0.75 and 0.58, respectively), but was worse for patients with S3 symptoms ( P < 0.001 for both). On multivariate analysis adjusting for final pathologic stage, grade, and LN status, S3 symptoms were not an independent predictor of recurrence (HR 1.44, P = 0.19) or death due to disease (HR 1.66, P = 0.07). Addition of symptom classification, however, increased the accuracy of a model consisting of stage, grade, and LNs for prediction of recurrence-free and cancer-specific survival by 1.4% and 1.3%, respectively ( P < 0.001 for both). Conclusions Local symptoms do not confer worse prognosis compared with patients with incidentally detected UTUC. However, systemic symptoms are associated with worse outcomes despite apparently effective RNU. Patients with systemic symptoms may harbor micrometastatic disease and could potentially benefit from a more rigorous metastatic evaluation or perioperative chemotherapy regimens. |
| doi_str_mv | 10.1016/j.urolonc.2009.11.007 |
| format | Article |
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Methods Data on 654 patients with localized UTUC who underwent RNU were reviewed. Preoperative symptoms were classified as incidental (S1), local (S2), and systemic (S3). Clinical and pathologic data were compared between the cohorts. Kaplan-Meier analyses and Cox proportional hazard modeling were used to determine recurrence-free and cancer-specific survival amongst the symptom cohorts. Results Symptom classification was S1 in 213 (33%) patients, S2 in 402 (61%), and S3 in 39 (6%). S3 symptoms were associated with advanced pathology, including higher stage, grade, and lymph node (LN) positivity. Five and 10-year recurrence-free and cancer-specific survival estimates were similar for patients with S1 and S2 symptoms ( P = 0.75 and 0.58, respectively), but was worse for patients with S3 symptoms ( P < 0.001 for both). On multivariate analysis adjusting for final pathologic stage, grade, and LN status, S3 symptoms were not an independent predictor of recurrence (HR 1.44, P = 0.19) or death due to disease (HR 1.66, P = 0.07). Addition of symptom classification, however, increased the accuracy of a model consisting of stage, grade, and LNs for prediction of recurrence-free and cancer-specific survival by 1.4% and 1.3%, respectively ( P < 0.001 for both). Conclusions Local symptoms do not confer worse prognosis compared with patients with incidentally detected UTUC. However, systemic symptoms are associated with worse outcomes despite apparently effective RNU. Patients with systemic symptoms may harbor micrometastatic disease and could potentially benefit from a more rigorous metastatic evaluation or perioperative chemotherapy regimens.</description><identifier>ISSN: 1078-1439</identifier><identifier>EISSN: 1873-2496</identifier><identifier>DOI: 10.1016/j.urolonc.2009.11.007</identifier><identifier>PMID: 20056458</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Carcinoma, Transitional Cell - classification ; Carcinoma, Transitional Cell - mortality ; Carcinoma, Transitional Cell - surgery ; Constitutional symptoms ; Female ; Flank pain ; Hematuria ; Humans ; Kaplan-Meier Estimate ; Male ; Medical sciences ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; Nephrectomy ; Nephrology. Urinary tract diseases ; Predictive Value of Tests ; Preoperative Care ; Prognosis ; Proportional Hazards Models ; Tumors ; Tumors of the urinary system ; Ureteral Neoplasms - classification ; Ureteral Neoplasms - mortality ; Ureteral Neoplasms - surgery ; Urinary tract. Prostate gland ; Urology ; Urothelial carcinoma</subject><ispartof>Urologic oncology, 2011-11, Vol.29 (6), p.716-723</ispartof><rights>Elsevier Inc.</rights><rights>2011 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c449t-cfa6916272f524247d939c2932f2fea7a6cab377e479be85b20b1d55483807be3</citedby><cites>FETCH-LOGICAL-c449t-cfa6916272f524247d939c2932f2fea7a6cab377e479be85b20b1d55483807be3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1078143909003603$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25229514$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20056458$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Raman, Jay D., M.D</creatorcontrib><creatorcontrib>Shariat, Shahrokh F., M.D</creatorcontrib><creatorcontrib>Karakiewicz, Pierre I., M.D</creatorcontrib><creatorcontrib>Lotan, Yair, M.D</creatorcontrib><creatorcontrib>Sagalowsky, Arthur I., M.D</creatorcontrib><creatorcontrib>Roscigno, Marco, M.D</creatorcontrib><creatorcontrib>Montorsi, Francesco, M.D</creatorcontrib><creatorcontrib>Bolenz, Christian, M.D</creatorcontrib><creatorcontrib>Weizer, Alon Z., M.D</creatorcontrib><creatorcontrib>Wheat, Jeffery C., M.D</creatorcontrib><creatorcontrib>Ng, Casey K., M.D</creatorcontrib><creatorcontrib>Scherr, Douglas S., M.D</creatorcontrib><creatorcontrib>Remzi, Mesut, M.D</creatorcontrib><creatorcontrib>Waldert, Matthias, M.D</creatorcontrib><creatorcontrib>Wood, Christopher G., M.D</creatorcontrib><creatorcontrib>Margulis, Vitaly, M.D</creatorcontrib><creatorcontrib>Upper-Tract Urothelial Carcinoma Collaborative Group</creatorcontrib><title>Does preoperative symptom classification impact prognosis in patients with clinically localized upper-tract urothelial carcinoma managed by radical nephroureterectomy?</title><title>Urologic oncology</title><addtitle>Urol Oncol</addtitle><description>Abstract Objectives To evaluate if preoperative symptom classification could refine prediction of outcomes for patients with clinically localized upper-tract urothelial carcinoma (UTUC) managed by radical nephroureterectomy (RNU). Methods Data on 654 patients with localized UTUC who underwent RNU were reviewed. Preoperative symptoms were classified as incidental (S1), local (S2), and systemic (S3). Clinical and pathologic data were compared between the cohorts. Kaplan-Meier analyses and Cox proportional hazard modeling were used to determine recurrence-free and cancer-specific survival amongst the symptom cohorts. Results Symptom classification was S1 in 213 (33%) patients, S2 in 402 (61%), and S3 in 39 (6%). S3 symptoms were associated with advanced pathology, including higher stage, grade, and lymph node (LN) positivity. Five and 10-year recurrence-free and cancer-specific survival estimates were similar for patients with S1 and S2 symptoms ( P = 0.75 and 0.58, respectively), but was worse for patients with S3 symptoms ( P < 0.001 for both). On multivariate analysis adjusting for final pathologic stage, grade, and LN status, S3 symptoms were not an independent predictor of recurrence (HR 1.44, P = 0.19) or death due to disease (HR 1.66, P = 0.07). Addition of symptom classification, however, increased the accuracy of a model consisting of stage, grade, and LNs for prediction of recurrence-free and cancer-specific survival by 1.4% and 1.3%, respectively ( P < 0.001 for both). Conclusions Local symptoms do not confer worse prognosis compared with patients with incidentally detected UTUC. However, systemic symptoms are associated with worse outcomes despite apparently effective RNU. Patients with systemic symptoms may harbor micrometastatic disease and could potentially benefit from a more rigorous metastatic evaluation or perioperative chemotherapy regimens.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Carcinoma, Transitional Cell - classification</subject><subject>Carcinoma, Transitional Cell - mortality</subject><subject>Carcinoma, Transitional Cell - surgery</subject><subject>Constitutional symptoms</subject><subject>Female</subject><subject>Flank pain</subject><subject>Hematuria</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoplasm Grading</subject><subject>Neoplasm Staging</subject><subject>Nephrectomy</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Predictive Value of Tests</subject><subject>Preoperative Care</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Tumors</subject><subject>Tumors of the urinary system</subject><subject>Ureteral Neoplasms - classification</subject><subject>Ureteral Neoplasms - mortality</subject><subject>Ureteral Neoplasms - surgery</subject><subject>Urinary tract. Prostate gland</subject><subject>Urology</subject><subject>Urothelial carcinoma</subject><issn>1078-1439</issn><issn>1873-2496</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFks-O1SAUxhujccarj6BhY1y1AqWlbJyYcfyTTOJCXRNKT-dybaFCO6a-0Lymp7l3NHHjCgK_73D4vpNlzxktGGX160OxxDAEbwtOqSoYKyiVD7Jz1sgy50LVD3FPZZMzUaqz7ElKB0qZaBh7nJ2hpKpF1Zxnd-8CJDJFCBNEM7tbIGkdpzmMxA4mJdc7i8fBEzdOxs6IhhsfkkvEeTLhFfg5kZ9u3qPAeaSHYSVDwNX9go4sExbO57hpseN5D4MzA7EmWufDaMhovLlBsF1JNN2mJx6mfQxLhBkiWOxlvXiaPerNkODZad1l395ffb38mF9__vDp8u11boVQc257UytWc8n7igsuZKdKZbkqec97MNLU1rSllCCkaqGpWk5b1lWVaMqGyhbKXfbqWBf_-WOBNOvRJQvDYDyEJWlFBbrIlUSyOpI2hpQi9HqKbjRx1YzqLSJ90KeI9BaRZkxjRKh7cXphaUfo_qjuM0Hg5QkwCd3oo_HWpb9cxbmqMNVddnHkAP24dRB1spiGhc5trukuuP-28uafCvcRfocV0gEj8Gi2ZjpxTfWXbZ62caKK0rKmZfkbKCvMnQ</recordid><startdate>20111101</startdate><enddate>20111101</enddate><creator>Raman, Jay D., M.D</creator><creator>Shariat, Shahrokh F., M.D</creator><creator>Karakiewicz, Pierre I., M.D</creator><creator>Lotan, Yair, M.D</creator><creator>Sagalowsky, Arthur I., M.D</creator><creator>Roscigno, Marco, M.D</creator><creator>Montorsi, Francesco, M.D</creator><creator>Bolenz, Christian, M.D</creator><creator>Weizer, Alon Z., M.D</creator><creator>Wheat, Jeffery C., M.D</creator><creator>Ng, Casey K., M.D</creator><creator>Scherr, Douglas S., M.D</creator><creator>Remzi, Mesut, M.D</creator><creator>Waldert, Matthias, M.D</creator><creator>Wood, Christopher G., M.D</creator><creator>Margulis, Vitaly, M.D</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20111101</creationdate><title>Does preoperative symptom classification impact prognosis in patients with clinically localized upper-tract urothelial carcinoma managed by radical nephroureterectomy?</title><author>Raman, Jay D., M.D ; Shariat, Shahrokh F., M.D ; Karakiewicz, Pierre I., M.D ; Lotan, Yair, M.D ; Sagalowsky, Arthur I., M.D ; Roscigno, Marco, M.D ; Montorsi, Francesco, M.D ; Bolenz, Christian, M.D ; Weizer, Alon Z., M.D ; Wheat, Jeffery C., M.D ; Ng, Casey K., M.D ; Scherr, Douglas S., M.D ; Remzi, Mesut, M.D ; Waldert, Matthias, M.D ; Wood, Christopher G., M.D ; Margulis, Vitaly, M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c449t-cfa6916272f524247d939c2932f2fea7a6cab377e479be85b20b1d55483807be3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Carcinoma, Transitional Cell - classification</topic><topic>Carcinoma, Transitional Cell - mortality</topic><topic>Carcinoma, Transitional Cell - surgery</topic><topic>Constitutional symptoms</topic><topic>Female</topic><topic>Flank pain</topic><topic>Hematuria</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neoplasm Grading</topic><topic>Neoplasm Staging</topic><topic>Nephrectomy</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Predictive Value of Tests</topic><topic>Preoperative Care</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Tumors</topic><topic>Tumors of the urinary system</topic><topic>Ureteral Neoplasms - classification</topic><topic>Ureteral Neoplasms - mortality</topic><topic>Ureteral Neoplasms - surgery</topic><topic>Urinary tract. Prostate gland</topic><topic>Urology</topic><topic>Urothelial carcinoma</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Raman, Jay D., M.D</creatorcontrib><creatorcontrib>Shariat, Shahrokh F., M.D</creatorcontrib><creatorcontrib>Karakiewicz, Pierre I., M.D</creatorcontrib><creatorcontrib>Lotan, Yair, M.D</creatorcontrib><creatorcontrib>Sagalowsky, Arthur I., M.D</creatorcontrib><creatorcontrib>Roscigno, Marco, M.D</creatorcontrib><creatorcontrib>Montorsi, Francesco, M.D</creatorcontrib><creatorcontrib>Bolenz, Christian, M.D</creatorcontrib><creatorcontrib>Weizer, Alon Z., M.D</creatorcontrib><creatorcontrib>Wheat, Jeffery C., M.D</creatorcontrib><creatorcontrib>Ng, Casey K., M.D</creatorcontrib><creatorcontrib>Scherr, Douglas S., M.D</creatorcontrib><creatorcontrib>Remzi, Mesut, M.D</creatorcontrib><creatorcontrib>Waldert, Matthias, M.D</creatorcontrib><creatorcontrib>Wood, Christopher G., M.D</creatorcontrib><creatorcontrib>Margulis, Vitaly, M.D</creatorcontrib><creatorcontrib>Upper-Tract Urothelial Carcinoma Collaborative Group</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Urologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Raman, Jay D., M.D</au><au>Shariat, Shahrokh F., M.D</au><au>Karakiewicz, Pierre I., M.D</au><au>Lotan, Yair, M.D</au><au>Sagalowsky, Arthur I., M.D</au><au>Roscigno, Marco, M.D</au><au>Montorsi, Francesco, M.D</au><au>Bolenz, Christian, M.D</au><au>Weizer, Alon Z., M.D</au><au>Wheat, Jeffery C., M.D</au><au>Ng, Casey K., M.D</au><au>Scherr, Douglas S., M.D</au><au>Remzi, Mesut, M.D</au><au>Waldert, Matthias, M.D</au><au>Wood, Christopher G., M.D</au><au>Margulis, Vitaly, M.D</au><aucorp>Upper-Tract Urothelial Carcinoma Collaborative Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does preoperative symptom classification impact prognosis in patients with clinically localized upper-tract urothelial carcinoma managed by radical nephroureterectomy?</atitle><jtitle>Urologic oncology</jtitle><addtitle>Urol Oncol</addtitle><date>2011-11-01</date><risdate>2011</risdate><volume>29</volume><issue>6</issue><spage>716</spage><epage>723</epage><pages>716-723</pages><issn>1078-1439</issn><eissn>1873-2496</eissn><abstract>Abstract Objectives To evaluate if preoperative symptom classification could refine prediction of outcomes for patients with clinically localized upper-tract urothelial carcinoma (UTUC) managed by radical nephroureterectomy (RNU). Methods Data on 654 patients with localized UTUC who underwent RNU were reviewed. Preoperative symptoms were classified as incidental (S1), local (S2), and systemic (S3). Clinical and pathologic data were compared between the cohorts. Kaplan-Meier analyses and Cox proportional hazard modeling were used to determine recurrence-free and cancer-specific survival amongst the symptom cohorts. Results Symptom classification was S1 in 213 (33%) patients, S2 in 402 (61%), and S3 in 39 (6%). S3 symptoms were associated with advanced pathology, including higher stage, grade, and lymph node (LN) positivity. Five and 10-year recurrence-free and cancer-specific survival estimates were similar for patients with S1 and S2 symptoms ( P = 0.75 and 0.58, respectively), but was worse for patients with S3 symptoms ( P < 0.001 for both). On multivariate analysis adjusting for final pathologic stage, grade, and LN status, S3 symptoms were not an independent predictor of recurrence (HR 1.44, P = 0.19) or death due to disease (HR 1.66, P = 0.07). Addition of symptom classification, however, increased the accuracy of a model consisting of stage, grade, and LNs for prediction of recurrence-free and cancer-specific survival by 1.4% and 1.3%, respectively ( P < 0.001 for both). Conclusions Local symptoms do not confer worse prognosis compared with patients with incidentally detected UTUC. However, systemic symptoms are associated with worse outcomes despite apparently effective RNU. Patients with systemic symptoms may harbor micrometastatic disease and could potentially benefit from a more rigorous metastatic evaluation or perioperative chemotherapy regimens.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>20056458</pmid><doi>10.1016/j.urolonc.2009.11.007</doi><tpages>8</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Carcinoma, Transitional Cell - classification Carcinoma, Transitional Cell - mortality Carcinoma, Transitional Cell - surgery Constitutional symptoms Female Flank pain Hematuria Humans Kaplan-Meier Estimate Male Medical sciences Middle Aged Neoplasm Grading Neoplasm Staging Nephrectomy Nephrology. Urinary tract diseases Predictive Value of Tests Preoperative Care Prognosis Proportional Hazards Models Tumors Tumors of the urinary system Ureteral Neoplasms - classification Ureteral Neoplasms - mortality Ureteral Neoplasms - surgery Urinary tract. Prostate gland Urology Urothelial carcinoma |
| title | Does preoperative symptom classification impact prognosis in patients with clinically localized upper-tract urothelial carcinoma managed by radical nephroureterectomy? |
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