[Transitional cell carcinoma of the upper urinary tract new concepts in management].
Transitional cell carcinomas of the upper urinary tract (UUT-TCCs) are rare: they account for approximately 5% of all urothelial carcinomas. 30% of patients with UUT-TCC have a history of bladder TCC, but fewer than 2% of patients with bladder TCC have UUT-TCC. Tumor microsatellite instability (MSI) is an indicator of the clonal expansion of neoplasms; it was first identified in tumors from patients with hereditary non-polyposis colorectal carcinoma (HNPCC). UUT-TCC occurs in 5% of patients with HNPCC. High-frequency microsatellite instability is present in almost 20% of cases of sporadic UUT-TCC. In cases of UUT-TCC with high-frequency MSI, hereditary cancer must be sought, especially if the patient is younger than 60 years or has a personal or family history of an HNPCC-related cancer: such patients should undergo DNA sequencing for the MSH2 gene germline mutation. Invasive UUT-TCC has a poor prognosis. 5-year survival is less than 50% for stage T2-T3 tumors and less than 10% for T4 or N+/M+ tumors. The main prognostic factors are age and tumor stage and grade. High-frequency MSI is a positive prognostic factor, especially in patients younger than 70 years with T2/T3/N0-M0 tumors.
Rouprêt
Morgan
M
Services d'urologie du GHU Est Pitié-Tenon, Assistance Publique-Hôpitaux de Paris, Groupe CeRePP, UFR Biomédicale, Université Paris V et unité EA 3104, Université Paris VII (75). mroupret@club-internet.fr
Cussenot
Olivier
O
D000367:Age Factors; D000368:Aged; D001483:Base Sequence; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000150:complications* / Q000235:genetics; D005260:Female; D005817:Genetic Counseling; D005819:Genetic Markers; D018095:Germ-Line Mutation; D006801:Humans; D007668:Kidney / Q000473:pathology; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D018895:Microsatellite Repeats / Q000235:genetics*; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000235:genetics; D016133:Polymerase Chain Reaction; D011379:Prognosis; D012307:Risk Factors; D014513:Ureter / Q000473:pathology; D014516:Ureteral Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000628:therapy; D014567:Urography
D005819:Genetic Markers