LONG-TERM FOLLOW-UP OF ENDOSCOPICALLY TREATED UPPER URINARY-TRACT TRANSITIONAL-CELL CARCINOMA

Objectives. This report focuses on the long-term follow-up of patients with endoscopically treated upper tract transitional cell carcinoma ( TCC) to determine the effectiveness of endoscopic therapy. Methods. Fr om May 1983 to April 1994, 44 patients with TCC of the upper urinary t ract underwent conservative endourologic treatment with either electro cautery fulguration or neodymium :yttrium-aluminum-garnet laser at our institution. The mean follow-up period was 5 years (range, 3 months t o 11 years). Results. Renal pelvic tumor sizes ranged from 0.4 to 4.0 cm (mean, 1.5) and ureteral tumors from 0.2 to 1.0 cm (mean, 0.5). The majority of tumors were of pathologic grade 3 or less, and all were S tage T2 or less. Seventeen of 44 patients (38.6%) had local tumor recu rrence (mean time to recurrence, 12.8 months; range 1.5 to 64). Mean r ecurrence time was 7.5 months for renal pelvic tumors and 17.8 months for ureteral tumors. Nineteen of 44 patients (43.2%) developed bladder tumors. The overall 5-year disease-free rate was 57%. No recurrent tu mor was shown to have increased in grade, and one recurrent tumor was proved to have progressed in stage. Six patients (14%) ultimately requ ired a nephroureterectomy for recurrence. There were no major complica tions as a result of endoscopic therapy. Six patients (14%) died of th e effects of metastatic TCC, 5 of whom had known muscle invasive bladd er TCC. Conclusions. Endourologic techniques and the conservative trea tment of upper urinary tract TCC is an evolving field and can be safel y and effectively used as a first-line treatment for upper tract TCC i n selected patients.