Impact of multimodal treatment on prognosis for patients with metastatic upper urinary tract urothelial cancer

Subanalysis of the multi-institutional nationwide case series study of the Japanese Urological Association

Junichi Inokuchi, Seiji Naito, Hiroyuki Fujimoto, Tomohiko Hara, Mizuaki Sakura, Hiroyuki Nishiyama, Jun Miyazaki, Eiji Kikuchi, Shiro Hinotsu, Takuya Koie, Chikara Ohyama, Hiroomi Kanayama, Tsuneharu Miki, Kazuhiro Suzuki, Masatoshi Eto, Hiroyuki Nakanishi, Tomoharu Fukumori

Research output: Contribution to journalArticle

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Abstract

Objectives: To describe the nature of metastatic upper urinary tract urothelial cancer and determine the prognostic predictors or treatment modality associated with all-cause mortality. Methods: Within the nationwide case series study of the Japanese Urological Association, consisting of 1509 patients with urinary tract urothelial cancer diagnosed in 2005, we identified 102 patients with metastatic urinary tract urothelial cancer. Univariate and multivariate survival analyses identified prognostic outcome variables. Results: Predominant sites of distant metastasis at diagnosis were the lungs (54.9%), distant lymph nodes (37.3%), bone (32.4%) and liver (19.6%). Of 102 patients, 70 patients (68.6%) died during the median follow-up period of 6 months, and the 2-year overall survival rate was estimated at 22%. The median survival time to all-cause mortality was 8.5 months (95% confidence interval 6.4-10.7 months). On multivariate analysis, independent predictive factors for all-cause mortality were age (hazard ratio 2.36, P = 0.015) and liver metastasis (hazard ratio 2.35, P = 0.037). Patients who received multimodal treatment including chemotherapy and surgery showed significantly better prognosis (median survival time 25.8 months) compared with patients treated with chemotherapy alone (median survival time 7.3 months) or best supportive care (median survival time 4.3 months). Conclusions: Age at diagnosis and the presence of liver metastasis seem to have an impact on survival of metastatic urinary tract urothelial cancer patients. Multimodal treatment including systemic chemotherapy and surgery might result in better prognosis in some of these patients.

Original languageEnglish
Pages (from-to)224-230
Number of pages7
JournalInternational Journal of Urology
Volume23
Issue number3
DOIs
Publication statusPublished - Mar 1 2016

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Urologic Neoplasms
Combined Modality Therapy
Survival
Neoplasm Metastasis
Drug Therapy
Mortality
Liver
Multivariate Analysis
Survival Analysis
Survival Rate
Lymph Nodes
Confidence Intervals
Bone and Bones
Lung

Keywords

  • Japanese
  • Multimodal treatment
  • Prognosis
  • Survival
  • Upper urinary tract urothelial cancer

ASJC Scopus subject areas

  • Urology

Cite this

Impact of multimodal treatment on prognosis for patients with metastatic upper urinary tract urothelial cancer : Subanalysis of the multi-institutional nationwide case series study of the Japanese Urological Association. / Inokuchi, Junichi; Naito, Seiji; Fujimoto, Hiroyuki; Hara, Tomohiko; Sakura, Mizuaki; Nishiyama, Hiroyuki; Miyazaki, Jun; Kikuchi, Eiji; Hinotsu, Shiro; Koie, Takuya; Ohyama, Chikara; Kanayama, Hiroomi; Miki, Tsuneharu; Suzuki, Kazuhiro; Eto, Masatoshi; Nakanishi, Hiroyuki; Fukumori, Tomoharu.

In: International Journal of Urology, Vol. 23, No. 3, 01.03.2016, p. 224-230.

Research output: Contribution to journalArticle

Inokuchi, J, Naito, S, Fujimoto, H, Hara, T, Sakura, M, Nishiyama, H, Miyazaki, J, Kikuchi, E, Hinotsu, S, Koie, T, Ohyama, C, Kanayama, H, Miki, T, Suzuki, K, Eto, M, Nakanishi, H & Fukumori, T 2016, 'Impact of multimodal treatment on prognosis for patients with metastatic upper urinary tract urothelial cancer: Subanalysis of the multi-institutional nationwide case series study of the Japanese Urological Association', International Journal of Urology, vol. 23, no. 3, pp. 224-230. https://doi.org/10.1111/iju.13031
Inokuchi, Junichi ; Naito, Seiji ; Fujimoto, Hiroyuki ; Hara, Tomohiko ; Sakura, Mizuaki ; Nishiyama, Hiroyuki ; Miyazaki, Jun ; Kikuchi, Eiji ; Hinotsu, Shiro ; Koie, Takuya ; Ohyama, Chikara ; Kanayama, Hiroomi ; Miki, Tsuneharu ; Suzuki, Kazuhiro ; Eto, Masatoshi ; Nakanishi, Hiroyuki ; Fukumori, Tomoharu. / Impact of multimodal treatment on prognosis for patients with metastatic upper urinary tract urothelial cancer : Subanalysis of the multi-institutional nationwide case series study of the Japanese Urological Association. In: International Journal of Urology. 2016 ; Vol. 23, No. 3. pp. 224-230.
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abstract = "Objectives: To describe the nature of metastatic upper urinary tract urothelial cancer and determine the prognostic predictors or treatment modality associated with all-cause mortality. Methods: Within the nationwide case series study of the Japanese Urological Association, consisting of 1509 patients with urinary tract urothelial cancer diagnosed in 2005, we identified 102 patients with metastatic urinary tract urothelial cancer. Univariate and multivariate survival analyses identified prognostic outcome variables. Results: Predominant sites of distant metastasis at diagnosis were the lungs (54.9{\%}), distant lymph nodes (37.3{\%}), bone (32.4{\%}) and liver (19.6{\%}). Of 102 patients, 70 patients (68.6{\%}) died during the median follow-up period of 6 months, and the 2-year overall survival rate was estimated at 22{\%}. The median survival time to all-cause mortality was 8.5 months (95{\%} confidence interval 6.4-10.7 months). On multivariate analysis, independent predictive factors for all-cause mortality were age (hazard ratio 2.36, P = 0.015) and liver metastasis (hazard ratio 2.35, P = 0.037). Patients who received multimodal treatment including chemotherapy and surgery showed significantly better prognosis (median survival time 25.8 months) compared with patients treated with chemotherapy alone (median survival time 7.3 months) or best supportive care (median survival time 4.3 months). Conclusions: Age at diagnosis and the presence of liver metastasis seem to have an impact on survival of metastatic urinary tract urothelial cancer patients. Multimodal treatment including systemic chemotherapy and surgery might result in better prognosis in some of these patients.",
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AU - Inokuchi, Junichi

AU - Naito, Seiji

AU - Fujimoto, Hiroyuki

AU - Hara, Tomohiko

AU - Sakura, Mizuaki

AU - Nishiyama, Hiroyuki

AU - Miyazaki, Jun

AU - Kikuchi, Eiji

AU - Hinotsu, Shiro

AU - Koie, Takuya

AU - Ohyama, Chikara

AU - Kanayama, Hiroomi

AU - Miki, Tsuneharu

AU - Suzuki, Kazuhiro

AU - Eto, Masatoshi

AU - Nakanishi, Hiroyuki

AU - Fukumori, Tomoharu

PY - 2016/3/1

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N2 - Objectives: To describe the nature of metastatic upper urinary tract urothelial cancer and determine the prognostic predictors or treatment modality associated with all-cause mortality. Methods: Within the nationwide case series study of the Japanese Urological Association, consisting of 1509 patients with urinary tract urothelial cancer diagnosed in 2005, we identified 102 patients with metastatic urinary tract urothelial cancer. Univariate and multivariate survival analyses identified prognostic outcome variables. Results: Predominant sites of distant metastasis at diagnosis were the lungs (54.9%), distant lymph nodes (37.3%), bone (32.4%) and liver (19.6%). Of 102 patients, 70 patients (68.6%) died during the median follow-up period of 6 months, and the 2-year overall survival rate was estimated at 22%. The median survival time to all-cause mortality was 8.5 months (95% confidence interval 6.4-10.7 months). On multivariate analysis, independent predictive factors for all-cause mortality were age (hazard ratio 2.36, P = 0.015) and liver metastasis (hazard ratio 2.35, P = 0.037). Patients who received multimodal treatment including chemotherapy and surgery showed significantly better prognosis (median survival time 25.8 months) compared with patients treated with chemotherapy alone (median survival time 7.3 months) or best supportive care (median survival time 4.3 months). Conclusions: Age at diagnosis and the presence of liver metastasis seem to have an impact on survival of metastatic urinary tract urothelial cancer patients. Multimodal treatment including systemic chemotherapy and surgery might result in better prognosis in some of these patients.

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KW - Japanese

KW - Multimodal treatment

KW - Prognosis

KW - Survival

KW - Upper urinary tract urothelial cancer

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