The impact factors on prognosis of patients with pT3 upper urinary tract transitional cell carcinoma.
OBJECTIVE
Stage 3 upper urinary tract transitional cell carcinoma is a heterogeneous disease including different tumor locations (pelvis vs ureter) and invasion patterns (renal parenchyma, peripelvic fat and periureteral fat). Unfortunately the outcomes of patients with pT3 disease with different invasion pattern are largely unknown. This study presents the clinical outcome of patients with pT3 disease with upper urinary tract transitional cell carcinoma.


METHODS
We retrospectively reviewed the medical records of all patients with pT3 disease with upper urinary tract transitional cell carcinoma. Four patient groups were classified according to tumor location and tumor invasion pattern. Prognostic factors including age, gender, tumor grade, tumor size, tumor number, tumor location and microscopic finding of vascular invasion were analyzed with respect to disease recurrence and survival.


RESULTS
A total of 72 patients were included in this study. The most common complaint and tumor relapse pattern were painless gross hematuria and distant metastasis, respectively. Patients with pT3 disease with superficial parenchymal invasion had better disease-free and recurrence-free survival than the other 3 groups. Initial tumor location (p = 0.02) and vascular invasion (p = 0.02) were independent factors for disease-free survival, and vascular invasion (p = 0.001) was the only predictive factor for recurrence-free survival.


CONCLUSIONS
The present study demonstrated that patients with pT3 disease with superficial parenchymal invasion should be considered to have lower stage disease, and that vascular involvement is the only independent prognostic factor for patients with pT3 disease for disease-free and recurrence-free survival. Systemic adjuvant therapy should be recommended for patients with pT3 disease with vascular involvement.
Wu
Ching-Fang
CF
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan, Republic of China. wuchingf@ms3.hinet.net
Pang
See-Tong
ST
Chen
Chih-Shou
CS
Chuang
Cheng-Keng
CK
Chen
Yu
Y
Lin
Paul-Yann
PY
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000098:blood supply / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D007682:Kidney Pelvis / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D008297:Male; D008833:Microcirculation / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D014516:Ureteral Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology* / Q000601:surgery