Prognostic factors for survival and bladder recurrence in transitional cell carcinoma of the upper urinary tract.
BACKGROUND
Prognostic factors for survival in transitional cell carcinoma of the upper urinary tract have been extensively evaluated, but detailed analyses of patterns of bladder recurrence after surgery have been rare.


METHODS
The outcome and tumor recurrence of 93 patients with transitional cell carcinoma of the upper urinary tract surgically treated between 1975 and 1999 were reviewed, retrospectively. Disease-specific survival by pathologic stage and grade were analyzed by the Kaplan-Meier


METHODS
Prognostic factors for survival and bladder recurrence were examined by univariate and multivariate analysis.


RESULTS
The 5-year disease-specific survival rates of the patients with pTa, T1 and T2 were 92.9%, 100% and 88.9%, respectively. However, that of the pT3 patients was 61.9% and the median survival of the pT4 cases was only 7 months. Bladder recurrence was seen in 40 cases and recurrences occurred within 1 year in 32 of these patients. The stage and grade of metachronous bladder tumors usually resembled those of primary tumors, but invasive recurrences were seen in 19% of recurrent cases with primary pTa, pT1 tumors. The significant prognostic factor for survival was pathologic stage (pT3, pT4), but no significant variables were detected for bladder recurrence by multivariate analysis.


CONCLUSIONS
The prognosis of pT3, pT4 patients is poor and effective systemic adjuvant therapy is necessary. Invasive bladder recurrence occurred in 19% of patients with superficial primary tumors. As no significant prognostic variables for bladder recurrence were identified, careful follow up for bladder recurrence is important even if the primary tumors are non-invasive.
Morioka
M
M
Department of Urology, Kawasaki Medical School, Kurashiki, Japan. moriokam@med.kawasaki-m.ac.jp
Jo
Y
Y
Furukawa
Y
Y
Kinugawa
K
K
Sone
A
A
Matsuki
T
T
Kobayashi
T
T
Fujii
T
T
Tanaka
H
H
D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000494:pharmacology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology; D001500:BCG Vaccine / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000401:mortality*; D002945:Cisplatin / Q000494:pharmacology; D004317:Doxorubicin / Q000031:analogs & derivatives / Q000494:pharmacology; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000494:pharmacology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000401:mortality*; D014747:Vinblastine / Q000494:pharmacology
D000903:Antibiotics, Antineoplastic; D001500:BCG Vaccine; D014747:Vinblastine; D004317:Doxorubicin; C027260:pirarubicin; D002945:Cisplatin; D008727:Methotrexate