Original Article Oncological outcomes after radical nephroureterectomy for upper tract urothelial carcinoma: Comparison over the three decades Mehrad Adibi, 1 * Ramy Youssef, 1 * Shahrokh F Shariat, 3 Yair Lotan, 1 Christopher G Wood, 2 Arthur I Sagalowsky, 1 Richard Zigeuner, 4 Francesco Montorsi, 5 Christian Bolenz 6 and Vitaly Margulis 1 1 Department of Urology, UT Southwestern Medical Center, Dallas, 2 The University of Texas MD Anderson Cancer Center, Houston, Texas, 3 Department of Urology, Cornell University, New York City, New York, USA; 4 Medical University of Graz, Graz, Austria; 5 Department of Urology,Vita-Salute University, Milan, Italy; and 6 Mannheim Medical Center, University of Heidelberg, Mannheim, Germany Abbreviations & Acronyms BC = bladder cancer CIS = carcinoma in situ CSS = cancer-specific survival CT = computed tomography DFS = disease-free survival ECOG = Eastern Cooperative Oncology Group LND = lymph node dissection LVI = lymphovascular invasion RNU = radical nephroureterectomy SEER = Surveillance, Epidemiology, and End Results UTUC = upper tract urothelial carcinoma Correspondence: Vitaly Margulis M.D., Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Blvd , Dallas, TX 75390-9110, USA. Email: vitaly.margulis@ utsouthwestern.edu *These authors contributed equally to this work. Received 30 March 2012; accepted 5 July 2012. 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 neph- roureterectomy 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 1–250 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 neph- roureterectomy, endoscopic management of urothelial carcinoma and utilization of perioperative chemotherapy between decades 1 to 3. There were no significant differ- ences 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 signifi- cantly 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. Key words: decades, outcomes, upper tract, urothelial carcinoma. Introduction There have been modest albeit significant strides in defining optimal treatment for patients with urothelial carcinoma of the bladder during the past two decades. Refinements in surgical technique, improved risk stratification and use of perioperative chemotherapeutic agents have led to survival improvements. 1 However, similar advances have not been achieved in patients with UTUC, 2–4 Despite accounting for just 5% of all urothelial malig- nancies, UTUC continues to portend a poor prognosis, with approximately 28% of patients experiencing a recurrence of disease outside the bladder and 23% of patients dying of the disease within 5 years. 5 In addition, outcomes of patients with locally advanced UTUC after RNU continues to be dismal. 6 Because of its low incidence, trends in clinicopathological International Journal of Urology (2012) doi: 10.1111/j.1442-2042.2012.03110.x © 2012 The Japanese Urological Association 1