Upper urinary tract transitional cell carcinoma: location is not correlated with prognosis

• Published in: BJU international Vol. 109; no. 7; pp. 1037 - 1042
• Main Authors: Milojevic, Bogomir, Djokic, Milan, Sipetic‐Grujicic, Sandra, Milenkovic‐Petronic, Dragica, Vuksanovic, Aleksandar, Bumbasirevic, Uros, Vukovic, Ivan, Dragicevic, Dejan, Tulic, Cane
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2012; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Aged; Biological and medical sciences; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - secondary; Carcinoma, Transitional Cell - surgery; Confidence intervals; Disease-Free Survival; Female; Humans; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Male; Medical research; Medical sciences; Middle Aged; Neoplasm Recurrence, Local; Nephrectomy; Nephrology. Urinary tract diseases; Prognosis; recurrence; renal pelvis; survival; Survival Rate; transitional cell carcinoma; Tumors; Tumors of the urinary system; ureter; Ureter - surgery; Ureteral Neoplasms - mortality; Ureteral Neoplasms - pathology; Ureteral Neoplasms - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urogenital system; Urothelial cancer; Nephrology; Relapse; Urinary system disease; Prognosis; Renal pelvis; Urinary tract disease; Malignant tumor; Transitional cell carcinoma; Upper urinary tract transitional cell carcinoma; Survival; Urology; recurrence; Ureter; Localization; Cancer
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2011.10461.x

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Tumour location has been shown to be of prognostic importance in UUT‐TCC, with tumours of renal pelvis having a better prognosis than ureteral tumours. Patients from Balkan Endemic Nephropathy (BEN) areas had a higher frequency of pelvis tumours. Also, we found that belonging to a BEN area is an independent predictor of disease recurrence. OBJECTIVE •  To identify the impact of tumour location on the disease recurrence and survival of patients who were treated surgically for upper urinary tract transitional cell carcinoma (UUT‐TCC). PATIENTS AND METHODS •  A single‐centre series of 189 consecutive patients who were treated surgically for UUT‐TCC between January 1999 and December 2009 was evaluated. •  Patients who had previously undergone radical cystectomy, preoperative chemotherapy or contralateral UUT‐TCC were excluded. •  In all, 133 patients were available for evaluation. Tumour location was categorized as renal pelvis or ureter based on the location of the dominant tumour. •  Recurrence‐free probabilities and cancer‐specific survival were estimated using the Kaplan–Meier method and Cox regression analyses. RESULTS •  The 5‐year recurrence‐free and cancer‐specific survival estimates for the cohort in the present study were 66% and 62%, respectively. •  The 5‐year bladder‐only recurrence‐free probability was 76%. Using multivariate analysis, only pT classification (hazard ratio, HR, 2.46; P= 0.04) and demographic characteristics (HR, 2.86 for areas of Balkan endemic nephropathy, vs non‐Balkan endemic nephropathy areas; 95% confidence interval, 1.37–5.98; P= 0.005) were associated with disease recurrence •  Tumour location was not associated with disease recurrence in any of the analyses. •  There was no difference in cancer‐specific survival between renal pelvis and ureteral tumours (P= 0.476). •  Using multivariate analysis, pT classification (HR, 8.04; P= 0.001) and lymph node status (HR, 4.73; P= 0.01) were the only independent predictors associated with a worse cancer‐specific survival. CONCLUSION •  Tumour location is unable to predict outcomes in a single‐centre series of consecutive patients who were treated with radical nephroureterectomy for UUT‐TCC.