Upper urinary tract transitional cell carcinoma: location is not correlated with prognosis

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Tumour location has been shown to be of prognostic importance in UUT‐TCC, with tumours of renal pelvis having a better prognosis than ureteral tumours. Patients from Balkan Endemic Nephropathy (BEN) areas had a higher frequency of pelvis tumours. Also, we found that belonging to a BEN area is an independent predictor of disease recurrence. OBJECTIVE To identify the impact of tumour location on the disease recurrence and survival of patients who were treated surgically for upper urinary tract transitional cell carcinoma (UUT‐TCC). PATIENTS AND METHODS A single‐centre series of 189 consecutive patients who were treated surgically for UUT‐TCC between January 1999 and December 2009 was evaluated. Patients who had previously undergone radical cystectomy, preoperative chemotherapy or contralateral UUT‐TCC were excluded. In all, 133 patients were available for evaluation. Tumour location was categorized as renal pelvis or ureter based on the location of the dominant tumour. Recurrence‐free probabilities and cancer‐specific survival were estimated using the Kaplan–Meier method and Cox regression analyses. RESULTS The 5‐year recurrence‐free and cancer‐specific survival estimates for the cohort in the present study were 66% and 62%, respectively. The 5‐year bladder‐only recurrence‐free probability was 76%. Using multivariate analysis, only pT classification (hazard ratio, HR, 2.46; P= 0.04) and demographic characteristics (HR, 2.86 for areas of Balkan endemic nephropathy, vs non‐Balkan endemic nephropathy areas; 95% confidence interval, 1.37–5.98; P= 0.005) were associated with disease recurrence Tumour location was not associated with disease recurrence in any of the analyses. There was no difference in cancer‐specific survival between renal pelvis and ureteral tumours (P= 0.476). Using multivariate analysis, pT classification (HR, 8.04; P= 0.001) and lymph node status (HR, 4.73; P= 0.01) were the only independent predictors associated with a worse cancer‐specific survival. CONCLUSION Tumour location is unable to predict outcomes in a single‐centre series of consecutive patients who were treated with radical nephroureterectomy for UUT‐TCC.

Molecular profile of urothelial carcinoma of the upper urinary tract: are pelvicalyceal and ureteral tumors different?

“…There are conflicting results regarding the impact of tumor location on oncologic outcomes of patients with UTUC [5][6][7][8][9][10][11][12][13]. Most studies suffer from small and mixed patient populations and retrospective design bias.…”

“…Van der Poel and colleagues initially reported worse CSS for patients with pelvicalyceal or proximal ureteral tumors compared to distal ureteral tumors when adjusted for tumor stage, grade, and history of previous BC, but larger series did not find a significant impact on survival outcomes for different tumor locations of UTUC [5,[7][8][9]11]. Of particular interest is the analysis of 2824 patients from the SEER database, in which no differences in outcomes according to the tumor location were found, but interpretations are difficult due to inherent limitations of the SEER data [7].…”

“…However, the results are not uniform with various studies, showing worse outcomes for UTUC in the pelvicalyceal system, some demonstrating worse results for UTUC in the ureter and others failing to identify clinical difference based on tumor location [5][6][7][8][9][10][11][12][13]. Several authors have postulated that tumor focality, rather than location, is an important predictor of outcomes [10,12].…”

“…During the search for predictive parameters, many have evaluated the relationship between tumor location in the upper urinary tract and oncological outcomes to determine whether tumor biology and outcomes of UTUC differ according to location within the upper urinary tract [5][6][7][8][9][10][11][12][13]. However, the results are not uniform with various studies, showing worse outcomes for UTUC in the pelvicalyceal system, some demonstrating worse results for UTUC in the ureter and others failing to identify clinical difference based on tumor location [5][6][7][8][9][10][11][12][13].…”

Editorial Comment for Cormio et al.

“…Measurement of the level of obstruction was not made, however. 4,5 Circling back to the bacteremia analogy, not all infected upper tracts result in bacteremia with obstruction or ureteroscopy. Perhaps not all upper tract tumors seed the vascular and lymphatics, but does the risk exist?…”