Prognostic Factors for Survival in the Transitional Cell Carcinoma of the Upper Urinary Tract

Park, Sungchan; Hong, Bumsik; Kim, Yongjae; Kim, Choung Soo; Ahn, Hanjong

Abstract

PURPOSE: To assess the impact of traditional prognostic factors and tumor location on the survival of patients treated surgically for upper urinary tract transitional cell carcinoma(TCC).
MATERIALS AND METHODS
We retrospectively analyzed data from 84 patients with upper urinary tract TCC who underwent nephroureterectomy with bladder cuff(95%) or renal parenchymal sparing surgery(5%). Mean patient age was 59.5 years and median follow-up was 44.3 months. The influence of traditional prognostic factors including age, sex, tumor stage, grade, and location on 5-year disease-specific and 5-year recurrence(local recurrence or distant metastasis)-free survival rates were analyzed. The difference in survival rates between renal pelvis(n=43) and ureter(n=41) was analyzed according to the respective T stage and grade.
RESULTS
Overall 5-year disease-specific and recurrence-free survival rates were 84% and 73%, respectively. Significant prognostic factors for 5-year disease-specific and recurrence-free survival by univariate analysis were tumor stage, grade, and location. On multivariate analysis, tumor location was the only independent prognostic factor for survival. Patients with ureter tumor had worse prognosis than those with renal pelvis tumor in the same stage or grade.
CONCLUSIONS
When treating upper tract TCC with a radical nephroureterectomy, tumor location was the most significant factor influencing survival. Ureter TCC is associated with a higher local or distant recurrence than renal pelvis TCC even at the same stage or grade. A radical surgical attitude, including meticulous lymphadenectomy, may provide a therapeutic role in patients with invasive ureter TCC.