Contemporary conditional cancer-specific survival after radical nephroureterectomy in patients with nonmetastatic urothelial carcinoma of upper urinary tract.

Background And Objectives: To examine the effect of conditional survival on 5-year cancer-specific survival (CSS) probability after radical nephroureterectomy (RNU) in a contemporary cohort of patients with non-metastatic urothelial carcinoma of the upper urinary tract (UTUC).

Methods: Within the Surveillance, Epidemiology and End Results database (2004-2015), 6826 patients were identified. Conditional 5-year CSS estimates were assessed after event-free follow-up duration. Multivariable Cox regression (MCR) models predicted cancer-specific mortality (CSM) according to event-free follow-up length.

Results: Overall, 956 (14.0%) were T low grade(LG)N , 1305 (19.1%) T high grade(HG)N , 1215 (17.8%) T N , 2249 (32.9%) T N and 1101 (16.1%) T N /T N . From baseline, 93.4% to 94.2% in T LGN provided 5-year CSS and, respectively, 86.2% to 95.3% in T HGN , 77.5% to 87.8% in T N , 63.0% to 91.1% in T N , and 38.8% to 88.2% in T N /T N . In MCR models, relative to T LGN , T HGN (Hazard ratio [HR] 1.7), T N (HR 3.0), T N (HR: 5.2), and T N /T N (HR 11.9) were independent predictors of higher CSM. Conditional HRs decreased to levels equivalent to T LGN at 3 years vs 5 years of event-free survival for T HGN and all other groups, respectively.

Conclusions: A direct relationship exists between event-free follow-up and survival probability after RNU. From a clinical perspective, such survival estimates may have particular importance during preoperative counseling.