Tumor size greater than 3 cm predicts worse survival among patients surgically treated for upper urinary tract urothelial carcinoma (UTUC), new findings suggest.

In a study of 795 patients who underwent nephroureterectomy (RNU) for UTUC, Yan Shibing, MD, of West China Hospital, Sichuan University, Chengdu, and colleagues found that patients with tumors larger than 3 cm were 2.3 and 2.4 times more likely to die from their cancer and all causes, respectively, compared with patients who had smaller tumors. In addition, they were 2.2 times more likely to experience cancer recurrence.

The cohort had a median follow-up of 32 months, 313 (39.4%) patients died from UTUC, 321 (40.4%) experienced cancer recurrence, and 359 (45.1%) died from all causes.

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Of the 208 patients who underwent lymph node dissection, 159 (76.4%) had tumors larger than 3 cm and only 49 patients (23.6%) had smaller tumors, indicating that tumor size could be used as an objective variable for identifying candidates for lymph node dissection, the researchers reported online ahead of print in BJU International.

To the best of their knowledge, the study is the first multicenter investigation addressing the impact of tumor size on survival outcomes in patients with UTUC treated with RNU, the investigators stated.

They noted that newly updated UTUC guidelines, for the first time, include tumor size as a preoperative risk factor, based on its impact on survival outcomes. The authors pointed out, however, that no solid evidence has been available to support this except for a few studies with small sample sizes and indefinite conclusions. Dr Shibing and colleagues said their results represent important new evidence.

Tumor size “is a readily available parameter, can be accurately measured and has the great advantage of little discrepancy among observers,” they noted.