title: Analysis of the clinicopathological characteristics of patients with upper urinary tract transitional cell carcinoma.
abstract: OBJECTIVE
  To describe the clinicopathological characteristics of patients with upper urinary tract transitional cell carcinomas who are treated surgically and to analyze the occurrence of bladder tumors as well as the development of metastases outside the urinary tract.
  
  
  METHODS
  The study comprised a retrospective analysis of 25 patients treated between February 1994 and August 2006. The variables analyzed were: patient age, gender, and clinical presentation; diagnostic methods; pathologic characteristics at the primary site of the tumor (pelvis or ureter); tumor stage and grade; and presence of carcinoma in situ, microvascular invasion and squamous differentiation. The Kaplan-Meier method and the Log-Rank test were used for statistical analysis of bladder recurrence-free survival.
  
  
  RESULTS
  Eighty-four percent of patients were male, and macroscopic hematuria was the most common clinical presentation. The majority of cases (56%) were infiltrative (T2-T3) and high-grade (76%) tumors. Synchronous or metachronous bladder tumors were found in 72% of cases. Five (20%) patients had a history of bladder tumor before the diagnosis of upper urinary tract transitional cell carcinomas. The mean follow-up period was 36 months (range: 1.5 to 156). During the follow-up period, eleven (44%) patients developed bladder tumors. After five years, the probability of being free of bladder tumor recurrence was 40%. No pathological variable was predictive for bladder tumor recurrence. Four patients presented disease recurrence outside the urinary tract.
  
  
  CONCLUSIONS
  The presence of metachronous bladder tumors is more often observed after the diagnosis of upper urinary tract transitional cell carcinomas. All of these patients should undergo rigorous follow-up during the postoperative period. Only patients with infiltrative and high-grade tumors developed metastases outside the urinary tract.
authors.affiliation: Department of Urology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. cbmurta@uol.com.br
authors.forename: Claudio B
authors.initials: CB
authors.lastname: Murta
authors.forename: Alberto A
authors.initials: AA
authors.lastname: Antunes
authors.forename: Marcos F
authors.initials: MF
authors.lastname: Dall'Oglio
authors.forename: Alcides
authors.initials: A
authors.lastname: Mosconi
authors.forename: Kátia R
authors.initials: KR
authors.lastname: Leite
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000556:secondary; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D007682:Kidney Pelvis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000473:pathology; D010386:Pelvic Neoplasms / Q000556:secondary; D012189:Retrospective Studies; D014516:Ureteral Neoplasms / Q000473:pathology* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery