title: [A clinical study of renal pelvic and ureteral cancer: prognosis and frequency of subsequent bladder cancer following surgical treatment].
abstract: OBJECTIVE
  A retrospective investigation of patients presenting with renal pelvic and ureteral cancer was performed. This study focused on the prognostic factors and frequency of subsequent bladder cancer following surgical treatment.
  
  
  METHODS
  Forty-five patients presenting with transitional cell carcinoma, who had undergone nephroureterectomy at the Department of Urology, Okayama Central Hospital, from March 1990 to November 2000, were reviewed. Various factors were evaluated according to survival and non-bladder cancer occurrence rates. The Kaplan-Meier method was used in the analyses.
  
  
  RESULTS
  Patients consisted of 33 males and 12 females (mean age was 71.7). Seventeen patients exhibited renal pelvic cancer, 25 cases displayed ureteral cancer and three subjects presented with multiple cancers. Eleven patients had received treatment for precedent or coexistent superficial bladder cancer by transurethral resection. The overall 5-year survival rate was 71.9%. Ten patients died as a result of the disease; in all cases, lymph node or distant metastasis had progressed. Pathological T factor, tumor grade and pN factor demonstrated a significant effect on survival; however, sex, age, tumor localization and incidence of subsequent bladder cancer had no influence on survival. The 5-year non-bladder cancer occurrence rate was 38.8%; additionally, all subsequent bladder cancer was disclosed within three years. Tumor multiplicity exclusively in the upper urinary tract significantly affected occurrence of bladder cancer. T factor and tumor grade revealed no correlation to occurrence.
  
  
  CONCLUSIONS
  Adjuvant chemotherapy for prevention of clinical metastasis should be considered in cases involving pT3 or higher stage, grade 3, or in instances of pathologically confirmed lymph node metastasis. The significant occurrence of subsequent bladder cancer in the case of tumor multiplicity suggested that prophylactic therapy such as intravesical BCG instillation or chemotherapy might be beneficial.
authors.affiliation: Department of Urology, Okayama Central Hospital.
authors.forename: Masami
authors.initials: M
authors.lastname: Watanabe
authors.forename: Toshihide
authors.initials: T
authors.lastname: Hayashi
authors.forename: Masatake
authors.initials: M
authors.lastname: Takamatsu
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kamitani
authors.forename: Miyabi
authors.initials: M
authors.lastname: Inoue
authors.forename: Koichi
authors.initials: K
authors.lastname: Morisue
authors.forename: Shin
authors.initials: S
authors.lastname: Irie
authors.forename: Tetsuzo
authors.initials: T
authors.lastname: Kaneshige
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007682:Kidney Pelvis; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000209:etiology* / Q000401:mortality