Grade Concordance between Transitional Cell Carcinoma of the Bladder and the Upper Urinary Tract

Woo, Kwang Jae; Kwak, Kyung Won; Choi, Han Yong; Lee, Hyun Moo

Abstract

PURPOSE: Transitional cell carcinoma(TCC) is thought to involve the entire urothelium as a multifocal field change. The tumor grade is a major prognostic factor in TCC and predicting the grade of TCC may be of clinical significance. The objective of this study is to clarify the grade concordance between upper tract TCC and bladder TCC.
MATERIALS AND METHODS
From 1994 to 2006, a total of 241 patients underwent nephroureterectomy for upper tract TCC. Seventy-four of the 241 patients who had a history of previous bladder cancer and/or synchronous or metachronous bladder TCC were included in this study. The grade was recorded for each tumor. Fisher's exact test of concordance was used for statistical analysis.
RESULTS
For the 74 patients who were analyzed, 42 patients(56.8%) developed bladder TCC during their follow up after nephroureterectomy, 14 patients(18.9%) had a history of bladder TCC prior to nephroureterectomy and 18 patients(24.3%) had a synchronous bladder tumor. In the case of developing bladder TCC during their follow up after nephroureterectomy, the grade concordance is highest between upper tract TCC and bladder TCC in 81.0% of the cases(p=0.005). Overall, the concordance rate between the upper tract TCC grade and the bladder TCC grade was 77.0%(p<0.001).
CONCLUSIONS
Concordance of the TCC in the upper urinary tract and bladder was present in 77.0% of the cases. The patients who developed bladder tumor during their follow up after nephroureterectomy had the highest grade concordance between upper tract TCC and bladder TCC in 81.0% of the cases. This knowledge can have a significant impact on the therapeutic and follow up plans for transitional cell carcinoma.