title: Significant predictive factors for prognosis of primary upper urinary tract cancer after radical nephroureterectomy in Taiwanese patients.
abstract: OBJECTIVE
  To follow up the long-term prognosis of patients who underwent nephroureterectomy for primary upper urinary tract (UUT) cancer and to evaluate the predictive factors of tumour recurrence and survival.
  
  
  METHODS
  Between January 1990 and June 2005, 260 patients with primary UUT transitional cell carcinoma (TCC) underwent radical nephroureterectomy at our institution. The medical records of these patients were retrospectively reviewed. The clinical and histopathological data were analyzed to evaluate predictive factors.
  
  
  RESULTS
  The median follow-up time was 52 mo. In total, 89 patients (34.1%) developed subsequent bladder tumours. Predictive factors of bladder tumour recurrence were being male and having renal insufficiency. Local recurrence developed in 16 patients (6.2%); only the tumour stage was significantly associated with local recurrence. Metachronous contralateral UUT tumour was diagnosed in 12 patients (4.6%), with gender being the only predictive factor. Of the 260 patients, 167 (63.9%) were disease-free and alive at a median follow-up of 56.5 mo, and 45 (17.2%) died of urothelial cancer at a median period of 20 mo. Only the tumour stage was a prognostic factor to predict cancer-specific survival.
  
  
  CONCLUSIONS
  In patients with UUT-TCC after radical nephroureterectomy, tumour stage is the only prognostic factor for both local recurrence and cancer-specific survival. Male patients with renal insufficiency should be alerted to the possibility of bladder tumour recurrence. Because female patients were more likely to develop contralateral recurrences, renal ultrasonography, intravenous pyelography, or retrograde pyelography should be performed more frequently for female patients who live in the high-prevalence area.
authors.affiliation: Department of Urology, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Ching-Chia
authors.initials: CC
authors.lastname: Li
authors.forename: Tu-Hao
authors.initials: TH
authors.lastname: Chang
authors.forename: Wen-Jeng
authors.initials: WJ
authors.lastname: Wu
authors.forename: Hung-Lung
authors.initials: HL
authors.lastname: Ke
authors.forename: Shu-Pin
authors.initials: SP
authors.lastname: Huang
authors.forename: Pei-Chien
authors.initials: PC
authors.lastname: Tsai
authors.forename: Shun-Jen
authors.initials: SJ
authors.lastname: Chang
authors.forename: Jung-Tsung
authors.initials: JT
authors.lastname: Shen
authors.forename: Yii-Her
authors.initials: YH
authors.lastname: Chou
authors.forename: Chun-Hsiung
authors.initials: CH
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D014516:Ureteral Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D014519:Ureterostomy / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D055815:Young Adult