Risk factors and survival in patients with recurrence of bladder tumors following surgery for transitional cell carcinoma of the upper urinary tract

Choi, Ho Cheol; Park, Choal Hee; Kim, Chun Il; Lee, Sung Choon

Abstract

Transitional cell carcinoma (TCC) of the upper urinary tract is a relatively rare malignancy that accounts for only 5 to 10% of all urothelial tumors. A patients with an upper tract TCC has a 25.8 % to 35.8 % probability of developing a subsequent TCC of the bladder. usually on the source of the upper tract TCC lesion. A retrospective analysis of 46 patients with an upper urinary tract (UUT) TCC which was treated surgically. was performed in relation to the development of a subsequent bladder tumor. In this study, we tried to clarify the risk factors of bladder tumor recurrence following surgery for UUT tumor and the survival rates of UUT tumor with and without a subsequent bladder tumor. Treatment for UUT tumor was total nephroureterectomy with bladder cuff excision in all 46 patients. In 25 of the 46 patients (54.3%), bladder tumors developed following surgery of a UUT tumor. Transurethral resection of bladder tumor and intravesical chemo- or immunotherapy were performed in all patients with subsequent bladder tumor. Patients with a subsequent bladder tumor consisted of multiple UUT tumor (12 patients), lower ureteral tumor (7 patients) and renal pelvis tumor (6 patients). The follow-up period varied from 24 months to 118 rnonths, with a mean of 64 months. Mean number of bladder recurrence was 2.5. The interval from surgery for UUT tumor to diagnosis of the initial bladder recurrence ranged from 8 months to 28 months, with a mean of 18 months. High stage and grade (>p T2, >G II), more than two tumors in the UUT and vascular or lymphatic invasion had a significant influence on the rate or bladder tumor recurrence (p<0.05). Difference of 5-rear survival rate of UUT tumor was insignificant in patient with (58%) and without (62%) subsequent bladder tumor (p<0.05).