title: Outcome of surgical treatment of patients with upper versus lower urinary tract urothelial carcinoma: stage-by-stage comparison.
abstract: 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.
authors.affiliation: Division of Urology, McGill University Health Center, Montreal, QC H3G 1A4, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Moussa
authors.forename: F A
authors.initials: FA
authors.lastname: Yafi
authors.forename: A
authors.initials: A
authors.lastname: El-Hakim
authors.forename: N
authors.initials: N
authors.lastname: Fahmy
authors.forename: A
authors.initials: A
authors.lastname: Aprikian
authors.forename: S
authors.initials: S
authors.lastname: Tanguay
authors.forename: M
authors.initials: M
authors.lastname: Anidjar
authors.forename: W
authors.initials: W
authors.lastname: Kassouf
mesh_terms: 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*