Oncology Evidence-based Sex-related Outcomes After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: Results of Large Multicenter Study Mario I. Fernández, Shahrokh F. Shariat, Vitaly Margulis, Christian Bolenz, Francesco Montorsi, Nazareno Suardi, Mesut Remzi, Christopher G. Wood, Marco Roscigno, Eiji Kikuchi, Mototsugu Oya, Richard Zigeuner, Cord Langner, Alon Weizer, Yair Lotan, Theresa M. Koppie, Jay D. Raman, Pierre Karakiewizc, Karim Bensalah, Marcela Schultz, and Pablo Bernier OBJECTIVES To assess the sex differences in the clinical and pathologic characteristics of upper tract urothelial carcinoma (UTUC) and to determine the effect on prognosis after radical nephroure- terectomy (RNU) in a large multicenter series. METHODS The records of 1363 patients who had undergone RNU were reviewed from the UTUC Collaboration database. The median follow-up was 47 months (range 0-250). The pathologic slides were re-evaluated by genitourinary pathologists unaware of the original findings from the slides and the clinical outcomes. The endpoints were freedom from tumor recurrence and disease-specific survival. RESULTS The male-to-female ratio was 2.1:1. The women were older than the men at diagnosis (70  11 vs 68  11 years; P  .001). No significant sex-related differences were found in the presence of symptoms at presentation (P = .70), pathologic stage (P = .98), tumor grade (P = .28), tumor architecture (P = .27), presence of lymphovascular invasion (P = .42), presence of concomitant carcinoma in situ (P = .08), or the presence of lymph node metastases (P = .24). Recurrence developed in 379 patients (28%), and 313 patients (23%) died of their disease. Sex was not associated with disease recurrence (P = .07) or disease-specific survival (P = .13). An adjustment for the effects of the pathologic features did not change the lack of association of sex with the clinical outcomes. CONCLUSIONS To our knowledge, this is the largest series analyzing the effect of sex on the outcomes after RNU. No difference was found in the clinicopathologic features or prognosis between women and men treated with RNU for UTUC. The results of this large, international series show that RNU provides durable local control and disease-specific survival for both men and women with UTUC. UROLOGY 73: 142–146, 2009. © 2009 Published by Elsevier Inc. P rimary upper tract urothelial carcinoma (UTUC) is a rare urologic malignancy, accounting for approxi- mately 5% of all urothelial tumors. 1,2 Incidence re- ports have shown a slight increase in the incidence until the past decade, as well as a slight improvement in survival. 3 However, the current management recommendations have been determined mainly from retrospective series and ex- pert opinion because of a lack of controlled randomized trials. 4 Overall, UTUC is 2-3 times more common in men than in women in western countries. 3,4 In addition to the previously well-known differences between men and women regarding the prognosis of patients with bladder urothelial carcinoma (UC), 5-7 reports have also been published about the differences related to the clinical and pathologic characteristics from single-center series be- tween men and women treated for UTUC. 7 Moreover, and similar to bladder UC, it has been suggested that the stage-adjusted survival of UTUC among women could be From the Clinica Alemana, Santiago, Chile; University of Texas Southwestern Medical Center, Dallas, Texas; University of Texas M.D. Anderson Cancer Center, Houston, Texas; Mannheim Medical Center, University of Heidelberg, Heidelberg, Germany; Vita-Salute University, Milan, Italy; University of Montreal, Montreal, Quebec, Canada; University of Vienna, Vienna, Austria; Keio University School of Medicine, Tokyo, Japan; Medical University Graz, Graz, Austria; University of Michigan School of Medicine, Ann Arbor, Michigan; University of California, Davis, School of Medi- cine, Sacramento, California; Cornell University, New York, New York; and Univer- sity of Rennes, Rennes, France Reprint requests: Mario I. Fernández, M.D., Department of Urology, Clínica Alemana de Santiago, Av. Manquehue Norte 1410 Piso 12, Vitacura, Santiago de Chile, Chile. E-mail: mfernandeza@alemana.cl Submitted: June 8, 2008, accepted (with revisions): July 15, 2008 142 © 2009 Published by Elsevier Inc. 0090-4295/09/$34.00 doi:10.1016/j.urology.2008.07.042