Nephroureterectomy and segmental ureterectomy in the treatment of invasive upper tract urothelial carcinoma: a population-based study of 2299 patients.

PURPOSE: The TNM staging system represents the cornerstone for classifying patients with upper tract urothelial carcinoma (UTUC). We tested the prognostic impact of pT and pN stages on cancer-specific mortality (CSM) in a large population-based cohort of surgically treated patients with UTUC. METHODS: Our analyses relied on 2299 patients treated with nephroureterectomy (NU) or segmental ureterectomy (SU) for UTUC within nine Surveillance, Epidemiology and End Results registries between 1988 and 2004. CSM rates after surgery were graphically explored using Kaplan-Meier plots. Univariable and multivariable Cox regression models tested the effect of pT and pN stages on CSM, after adjusting for tumour grade, age, gender, primary tumour location, type and year of surgery. RESULTS: Five years after surgery, the overall CSM-free survival rate was 77.6%. The 5-year CSM-free survival rates of pT(1)N(0) (n=739), pT(2)N(0) (n=422), pT(3)N(0) (n=691), pT(4)N(0) (n=190) and any T N(1-3) (n=257) were, respectively, 93.5 versus 86.2 versus 64.5 versus 54.7 versus 35.0%. The 5-year CSM-free survival rates of pT(1-2)N(1-3) (n=41) and pT(3-4)N(1-3) (n=216) patients were, respectively, 68.9% and 28.7% (p=0.006). In multivariable analyses, pT and pN stages (p