Outcome of surgical treatment of patients with upper versus lower urinary tract urothelial carcinoma: stage-by-stage comparison.
OBJECTIVE
It remains controversial whether we can apply similar principles in the management of upper urinary tract urothelial carcinoma (UUT-UC) based on the behavior of bladder urothelial carcinoma (B-UC). We sought to assess whether UUT-UC and B-UC have similar biology and performed a stage-by-stage comparative analysis of outcome between the 2 groups.


METHODS
A retrospective review was performed on patients who underwent nephroureterectomy for UUT-UC and radical cystectomy for B-UC from 1991 to 2006. Standard variables were collected and recurrence-free and overall survival (OS) rates were calculated.


RESULTS
280 patients with a median age of 69 years were included (99 UUT-UC treated via nephroureterectomy and 181 B-UC treated via radical cystectomy). Median follow-up was 29 months. None received neoadjuvant chemotherapy. Patients with UUT-UC presented less commonly with invasive disease compared to those with B-UC (44 vs. 77% were >pT2). Overall, 5-year OS for the B-UC group was significantly lower than for the UUT-UC group (60.8 vs. 74.5%, p = 0.02). However, when patients were stratified by stage (>pT2), patients with B-UC had similar OS compared to those with UUT-UC (54.6 vs. 60.8%, p = 0.74).


CONCLUSIONS
Invasive UUT-UC appears to have similar tumor biology compared to B-UC. Whether we can safely extrapolate on the benefit of neoadjuvant and adjuvant strategies to patients with UUT-UC requires further investigation.
Moussa
S
S
Division of Urology, McGill University Health Center, Montreal, QC H3G 1A4, Canada.
Yafi
F A
FA
El-Hakim
A
A
Fahmy
N
N
Aprikian
A
A
Tanguay
S
S
Anidjar
M
M
Kassouf
W
W
D000328:Adult; D000368:Aged; D000465:Algorithms; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000473:pathology*; D015653:Cystectomy / Q000379:methods; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000473:pathology*