Prognostic Significance of Bladder Tumor History and Tumor Location in Upper Tract Transitional Cell Carcinoma

Abstract

High tumor stage and grade, and ureteral location were significantly associated with worse disease specific and recurrence-free survival in patients with upper urinary tract transitional cell carcinoma. Our results may help define the patient groups that need adjuvant therapy and they may form a basis for further controlled studies.

Independent predictors of cancer‐specific survival in transitional cell carcinoma of the upper urinary tract

“…Those proportions were far greater than what was reported previously in the literature, in which bladder TCC reportedly was present in from 9% to 20% of patients who underwent nephroureterectomy. 4,11,19 In our analysis, the presence of bladder cancer before the diagnosis of UUT-TCC turned out to be an independent predictor of the probability of cancer-specific survival, but this was because of the small number of patients with muscle-invasive bladder cancer, who underwent radical cystectomy before nephroureterectomy. Indeed, in our analyses, nonmuscle-invasive bladder TCC did not play a major prognostic role, and the small difference in the 5-year cancer-specific survival probabilities between patients without prior bladder cancer and patients with nonmuscle-invasive bladder cancer showed only a statistically nonsignificant trend.…”

“…11,20 Conversely, van der Poel et al demonstrated that patients who had tumors in the renal pelvis and proximal ureter were 2.5 times more likely to die of disease compared with patients who had tumors in the distal ureter, reconfirming the data even in multivariate analyses. 10 In our series, patients with pelvic or ureteral cancers had similar survival probabilities, which were higher than those for the patients who harbored concomitant pelvic and ureteral cancers, although the data were not significant on multivariate analysis.…”

“…4 With regard to histologic grade, data from the literature indicate 5-year cancer-specific survival probabilities in the range from 80% to 100% for patients with grade 1 UUT-TCC, from 33% to 94% for patients with grade 2 UUT-TCC, and from 11% to 40% for patients with grade 3 UUT-TCC. 4,11,12,16,17 Moreover, a few studies reported the independent prognostic role of grade, 11,18 indicating that patients who have high-grade cancers have an at least 2-fold increased risk of cancer-related death compared with patients FIGURE 4. Cancer-specific survival probabilities were stratified by pathologic tumor stage (pT) of the primary tumor (log-rank P < .001).…”

“…3 The knowledge of prognostic factors for UUT-TCC often is based on studies on the most common bladder TCC, and only a few studies on prognostic factors for UUT-TCC have been published to date, and those sometimes have reported conflicting data. Tumor stage [4][5][6][7][8][9][10][11] and histologic grade 7,11,12 are among the best established prognostic factors; whereas, conversely, the roles of other potentially relevant variables, such as a history of bladder cancer, tumor site, lymphovascular invasion, or multifocality, are less clear. [6][7][8]10,11 A clear knowledge of those prognostic data would be useful for counseling patients after surgery and for identifying those patients with unfavorable cancer-related outcome who may be candidates for future neoadjuvant or adjuvant randomized controlled trials.…”

Survival of patients with upper urinary tract urothelial carcinoma after nephroureterectomy and risk factors for bladder cancer

“…Iako je pozitivna istorija tumora mokraćne bešike bila značajno zastupljenija kod pacijenata sa tumorima uretera to nije uticalo na njihovo petogodišnje kancer specifično preživljavanje. Akdogan i saradnici su dokazali da pacijenti sa pozitivnom istorijom tumora mokraćne bešike imaju nižu stopu petogodišnjeg kancer specifičnog preživljavanja, kao i preživljavanja bez pojave recidiva [140]. Ipak neophodne su veće studije koje bi potvrdile da je prethodni tumor mokraćne bešike značajan prognostički faktor kod pacijenata sa tumorima gornjeg urotelijuma.…”