[Post-operative recurrence patterns of urothelial tumors in the upper urinary tract: comparison between renal pelvic and ureteral tumors].
To determine treatment outcomes for renal pelvic and ureteral tumors, we retrospectively evaluated the correlations between stage, area oflymphadenectomy (LND) and the recurrence pattern. Of 162 patients treated surgically for a urothelial tumor of the upper urinary tract from 1990 to 2006, we reviewed 57 renal pelvic and 55 ureteral, diagnosed as having either renal pelvic or ureteral tumors. We defined local recurrence as metastasis to the retroperitoneum, pelvis, and abdominal lymph nodes. Of the 112 patients, LND was performed in 76. No patient with pTis/a/1 disease showed pN(+); however, in pT2 < or = disease, 39% of the renal pelvis and 23% of the ureter cases exhibited nodal involvement. During follow up, 35 patients had relapse; 25 distant metastasis, 5 local recurrence, and 5 synchronous recurrence at both sites. In pT2/3 disease, the frequency of distant metastasis of a ureteral tumor was significantly higher than that in renal pelvic cases (55% vs. 19%, P = 0.0237). Local recurrence was found in 7 renal pelvic and 3 ureteral cases. Although all of these patients had previously undergone LND, local recurrence adjacent to the dissected area was confirmed in 6 cases. In pT2 < or = disease, ureteral tumors showed more frequent occurrences of distant metastasis, whereas local relapses adjacent to the dissected nodal areas were more prominent in renal pelvic cases. When deciding a therapeutic strategy in renal pelvic cases, careful consideration about an adequate region for LND appears important.
Sengiku
Atsushi
A
The Department of Urology, Kyoto University Graduate School of Medicine.
Nishiyama
Hiroyuki
H
Shimizu
Takashi
T
Watabe
Jun
J
Soda
Takeshi
T
Kamba
Tomomi
T
Yoshimura
Koji
K
Kanematsu
Akihiro
A
Nakamura
Eijiro
E
Kamoto
Toshiyuki
T
Ogawa
Osamu
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D007682:Kidney Pelvis; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D014516:Ureteral Neoplasms / Q000473:pathology / Q000601:surgery*