title: Patterns of failure and prognostic factors for locoregional recurrence after radical surgery in upper urinary tract transitional cell carcinoma: implications for adjuvant radiotherapy.
abstract: OBJECTIVE
  We investigated the patterns of failure and prognostic factors for locoregional control (LRC) in patients with upper urinary tract (UUT) transitional cell carcinoma (TCC) treated with radical surgery to evaluate the role of adjuvant radiotherapy.
  
  
  METHODS
  We retrospectively reviewed the medical records of 76 patients with TCC of the renal pelvis and ureter without distant metastasis who underwent curative-intent surgery. No locoregional or distant failure occurred in 19 patients with pTa-1 tumor, and we evaluated patterns of failure and prognostic factors in 57 patients with pT2 or more tumors. Adjuvant chemotherapy was applied in 25 patients.
  
  
  RESULTS
  Recurrences occurred in a total of 23 patients, and 20 of these experienced some kind of locoregional failure during follow-up. The overall crude and initial isolated locoregional recurrence rates were 35 and 28%, respectively. In pT2 patients, all 4 recurrences were isolated locoregional recurrences, and 3 of them were successfully salvaged with chemoradiotherapy. Patients with pT3-4 or who were positive for nodal disease (N+) had a lower rate of LRC and worse prognosis after recurrences. On multivariate analysis, incomplete surgery, venous invasion and squamous metaplasia were identified as independent prognostic factors for LRC.
  
  
  CONCLUSIONS
  Initial loco-regional recurrence was commonly detected by routine computed tomography in locally advanced UUT-TCC. Incomplete surgery, venous invasion and squamous metaplasia were independently associated with poor LRC. Active postoperative adjuvant treatment such as concurrent chemoradiotherapy could be considered in pT3-4 or N+ patients with adverse risk factors.
authors.affiliation: Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Na Young
authors.initials: NY
authors.lastname: Jang
authors.forename: In Ah
authors.initials: IA
authors.lastname: Kim
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Jae-Sung
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000473:pathology; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology; D014516:Ureteral Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery