Pattern of Recurrence and the Prognostic Factors of Upper Urinary Tract Transitional Cell Carcinoma

Kang Su Cho; Nam Hoon Cho; Young Deuk Choi

doi:10.4111/kju.2006.47.2.124

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Cho, Cho, and Choi: Pattern of Recurrence and the Prognostic Factors of Upper Urinary Tract Transitional Cell Carcinoma

Original Article

Korean J Urol 2006;47(2):124-130.

Published online: 18 December 2006

DOI: https://doi.org/10.4111/kju.2006.47.2.124

Pattern of Recurrence and the Prognostic Factors of Upper Urinary Tract Transitional Cell Carcinoma

Kang Su Cho, Nam Hoon Cho¹, Young Deuk Choi

¹Department of Pathology, Yonsei University College of Medicine, Seoul, Korea

²From the Department of Urology Urological Science Institute

Corresponding author: Choi Young-deuk Severance Hospital Urology 134, Sinchon-dong, Seodaemun-gu, Seoul ? 120-752 TEL: 02-2228-2317 FAX: 02-312-2538 E-mail: youngd74@yumc.yonsei.ac.kr

Received 27 June 2005 Accepted 5 September 2005

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

We evaluated the pattern of recurrence and the prognostic factors for patients who suffered with upper urinary tract transitional cell carcinoma (TCCa) and were surgically treated.

Materials and Methods:

Between 1986 and 2003, the medical records on 228 patients who were diagnosed and surgically treated for upper urinary tract TCCa were retrospectively analyzed with regard to the pattern of recurrence and the prognostic factors. The main site of the tumors was the renal pelvis in 127 patients and the ureter in 101 patients. Nephro- ureterectomy and/or bladder cuff resection was performed on 215 patients and conservative surgery was performed on 13 patients, respectively.

Results:

Recurrence developed in 75 patients (32.9%) and the mean time to recurrence was 23.9 months (3-120). Of these 75 patients, locoregional recurrence without metastasis occurred in 28.0%, locoregional recurrence with metastasis occurred in 25.3%, metastasis without locoregional recurrence occurred in 42.7% and contralateral upper tract recurrence occurred in 4%. There was no difference between the renal pelvic cancer and ureteral cancer regarding the pattern of recurrence. Meanwhile, 5-year recurrence-free and disease-specific survival rates were 63.9% and 69.7%, respectively. On univariate analysis, the T stage, tumor grade, lympho- vascular permeation, margin status and nodal status had a significant influence on recurrence-free survival and disease-specific survival. On multivariate analysis, the T stage and lymphovascular permeation were independent prognostic factors for upper urinary tract TCCa.

Conclusions:

Locoregional recurrence and metastasis frequently occurred in the upper urinary tract TCCa irrespective of the tumor location. The T stage and lymphovascular permeation were independent prognostic factors for the upper urinary tract TCCa. (Korean J Urol 2006;47:124-130)

Keywords: Transitional cell carcinoma, Ureter, Kidney pelvis, Recurrence, Prognosis

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Fig. 1.

Overall disease-specific survival probabilities for the patients with upper urinary tract transitional cell carcinoma.

Fig. 2.

Overall disease-specific survival probabilities for the patients with upper urinary tract transitional cell carcinoma according to the T stages.

Fig. 3.

Overall disease-specific survival probabilities for the patients with upper urinary tract transitional cell carcinoma according to the lymphovascular permeation. LV: lymphovascular permeation.

Fig. 4.

Overall disease-specific survival probabilities for the patients with upper urinary tract transitional cell carcinoma according to the tumor location.

Table 1.

Clinical characteristics of the patients with upper urinary tract transitional cell carcinoma

	No. of patients (%)
Age
<62.1 years∗	100 (43.9)
≥62.1 years∗	128 (56.1)
Sex
Male	162 (71.1)
Female	66 (28.9)
Location
Renal pelvis	127 (55.7)
Renal pelvis only	113(89.0)
Renal pelvis+ureter	14 (11.0)
Ureter	101 (44.3)
Ureter only	97 (96.1)
Ureter+renal pelvis	4 (3.9)
Previous bladder tumor
Yes	6 (2.6)
No	222 (97.4)
Concomitant bladder tumor
Yes	35 (15.4)
No	193 (84.6)
Operation
Nephroureterectomy	215 (94.3)
Segmental resection	10 (4.4)
Endoscopic resection	3 (1.3)
Bladder cuff resection
Yes	211 (92.5)
No	17 (7.5)
Lymphadenectomy
Yes	85 (37.3)
No	143 (62.7)
Adjuvant therapy
Chemotherapy	46 (20.1)
Radiotherapy	8 (3.5)

^∗ : mean age of the patients

Table 2.

Pathological characteristics of the patients with upper urinary tract transitional cell carcinoma

	No. of patients (%)
	Ureter	Renal pelvis	Total
T stage
Ta	11 (10.9)	19 (15.0)	30 (13.1)
T1	23 (22.8)	25 (19.7)	48 (21.1)
T2	30 (29.7)	14(11.0)	44 (19.3)
T3	35 (34.6)	59 (46.5)	94 (41.2)
T4	2 (2.0)	10 (7.8)	12 (5.3)
Tumor grade
I, II	27 (26.7)	29 (22.8)	56 (24.6)
III	74 (73.3)	98 (77.2)	172 (75.4)
Carcinoma in situ
Yes	11 (10.9)	6 (4.7)	17 (7.5)
No	90 (89.1)	121 (95.3)	211 (92.5)
Squamous differentiation
Yes	8 (7.9)	8 (6.3)	16 (7.0)
No	93 (92.1)	119(93.7)	212 (93.0)
Lymphovascular permeation
Yes	12(11.9)	22 (17.3)	34 (14.9)
No	89 (88.1)	105 (82.7)	194 (85.1)
Lymph node
Positive	9 (8.9)	15(11.8)	24 (10.5)
Negative	92 (91.1)	112(88.2)	204 (89.5)
Surgical margin
Positive	6 (5.9)	1 (0.8)	7(3.1)
Negative	95 (94.1)	126 (99.2)	221 (96.9)
Total	101 (44.3)	127 (55.7)	228 (100.0)

Table 3.

Pattern of tumor recurrence for the upper urinary tract transitional cell carcinoma and comparison of the recurrence patterns between the renal pelvis tumor and ureter tumor

Recurrence	No. of patients (%)
Recurrence	Renal pelvis	Ureter	Total
Locoregional only	11 (26.2)	10 (30.3)	21 (28.0)
Locoregional and metastatic	10 (23.8)	9 (27.3)	19 (25.3)
Metastatic only	18 (42.9)	14 (42.4)	32 (42.7)
Contralateral upper tract	3(7.1)	0 (0.0)	3 (4.0)
Total	42 (100)	33(100)	75 (100)

Table 4.

Univariate analysis for the recurrence-free survival rates and the disease-specific survival rates

Variables	5-year recurrence- free survival (%)	p-value	5-year disease- specific survival (%)	p-value
Age
く Mean age	67.7	NS	71.4	NS
>Mean age	60.8	NS	68.1	NS
Sex
Male	63.5	NS	69.1	NS
Female	63.1	NS	70.8	NS
Location
Renal pelvis	67.4	NS	73.6	NS
Ureter	57.8	NS	61.7	NS
T stage
Ta-1	93.3	<0.0001	97.9	< 0.0001
T2	60.2		64.0
T3	46.4		55.6
T4	19.4		27.5
Tumor grade
I, II	80.7	0.0028	82.5	0.0025
III	59.6		65.9
Lymphovascular permeation
Yes	31.4	< 0.0001	34.9	< 0.0001
No	69.3		75.4
Carcinoma in situ
Yes	48.4	NS	58.4	NS
No	64.2		70.6
Squamous differentiation
Yes	29.2	0.0029	63.8	NS
No	66.3		70.5
Surgical margin
Positive	00.0	0.0121	57.1	0.0418
Negative	65.6		70.3
Lymph node
Positive	26.6	0.0001	31.6	0.0001
Negative	67.3		74.3
Bladder recurrence
Yes	60.9	NS	69.5	NS
No	65.8		69.9

NS: statistically not significant

Table 5.

Multivariate analysis for the recurrence-free survival rates and the disease-specific survival rates

	Recurrence-free survival		Disease-specific survival
	Relative risk (95% CI)	p-value	Relative risk (95% CI)	p-value
T stage:
Ta-1 vs T2	7.41 (2.41-21.25)	< 0.001	22.70 (2.99-172.37)	0.003
Ta-1 vs T3	9.25 (3.25-26.35)	< 0.001	33.00 (4.47-243.24)	0.001
Ta-1 vs T4	33.17 (10.15-108.34)	< 0.001	104.29 (13.15-826.64)	< 0.001
Tumor grade	1.27 (0.48-3.36)	NS	1.76 (0.41-7.46)	NS
Lymphovascular permeation	2.71 (1.58-4.67)	< 0.001	2.40 (1.34-4.30)	0.003
Lymph node	1.54 (0.77-3.06)	NS	1.71 (0.85-3.43)	NS
Surgical margin	1.45 (0.55-3.80)	NS	1.49 (0.52-4.20)	NS
Squamous differentiation	1.95 (0.94-4.05)	NS	-	-

CI: confidence interval, NS: statistically not significant

Table 6.

Table 6. The comparison of the recurrence-free and disease-specific survival rates between the renal pelvis tumor and ureter tumor according to Τ stages

Stage	5-year recurrence-free survival (%)			5-year disease-specific survival (%)
Stage	Renal pelvis	Ureter	p-value	Renal pelvis	Ureter	p-value
Ta-1N0M0 (n=76)	94.5	94.7	NS	100.0	100.0	NS
T2N0M0 (n=44)	71.4	55.0	NS	70.7	59.4	NS
T3N0M0 (n=77)	56.0	36.1	NS	66.5	52.8	NS

NS: statistically not significant

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