Patterns of failure and influence of potential prognostic factors after surgery in transitional cell carcinoma of the upper urinary tract.
BACKGROUND
We investigated the long-term outcome of upper urinary tract transitional cell carcinoma (TCC) after surgery.


METHODS
The study population comprised 114 surgically treated patients with upper urinary tract TCC treated at Jikei University Hospital between March 1990 and December 2004. All these patients underwent radical surgery without any type of neoadjuvant therapy. Patterns of failure and patient survival were compared with clinicopathological parameters.


RESULTS
The 5- and 10-year overall survival (OAS) rates for the patients were 85% (95% confidence interval [CI], 81%-89%) and 76% (95% CI, 69%-83%). To date, 19 patients (16.7%) have experienced distant or lymph node metastasis at a mean of 13.3 months following surgery (range, 1 to 50 months). The site of the primary tumor did not affect patient survival (P > 0.05). Both lymphovascular involvement (LVI) and positive lymph nodes were found to have poor prognosis in univariate analysis (P = 0.004 and P < 0.0001). Multivariate analysis indicated pathological stage and bladder recurrence (bladder recurrence being a better prognostic factor) to be independent predictors of metastasis-free survival, but not of OAS or cause-specific survival (CSS).


CONCLUSIONS
Pathological stage and bladder recurrence were found to be the predictors of metastasis-free survival in this study. Further searching for reliable biomarkers is needed to accurately predict the prognosis of this malignancy.
Shimomura
Tatsuya
T
Department of Urology, Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan. shimomura@jikei.ac.jp
Ohtsuka
Norishige
N
Yamada
Hiroki
H
Miki
Jun
J
Hayashi
Norihiro
N
Kimura
Takahiro
T
Kuruma
Hidetoshi
H
Egawa
Shin
S
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate; D017211:Treatment Failure; D014571:Urologic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery