PROGNOSTIC FACTORS, RECURRENCE, AND SURVIVAL IN TRANSITIONAL-CELL CARCINOMA OF THE UPPER URINARY-TRACT - A 30-YEAR EXPERIENCE IN 252 PATIENTS

Objectives. To review a large single-center experience of patients tre ated for upper tract transitional cell carcinoma (TCC) with extended f ollow-up in order to identify patterns of recurrence, assess patient o utcomes, and determine the impact of traditional prognostic factors. M ethods. We reviewed 252 patients treated surgically for upper tract TC C with a median follow-up of 64 months. Most patients (77%) underwent nephroureterectomy, whereas 17% were treated with a parenchymal sparin g approach. Traditional prognostic factors including age, sex, tumor s tage, grade, location, and type of surgical treatment were analyzed wi th respect to disease recurrence and survival. Results. Disease relaps e occurred in 67 patients (27%) at a median time of 12.0 months. Recur rences were local in the retroperitoneum (9%), the bladder (51%), rema ining upper tract (18%), or distant in the lung, bone, or liver (22%). The 6 patients with local relapse were among the 73 patients with pT3 or pT4 tumors, and all died of TCC at a median time from diagnosis of 37 months. Significant prognostic factors for recurrence by univariat e analysis were tumor grade (P = 0.0014) and stage (P = 0.0001). On mu ltivariate analysis, only tumor stage (P = 0.017) and treatment modali ty (P = 0.020) were predictors of recurrence. Actuarial 5-year disease -specific survival rates by primary tumor stage were 100% for Ta/cis, 91.7% for T1, 72.6% for T2, and 40.5% for T3. Patients with primary St age T4 tumors had a median survival of 6 months. Although tumor stage and grade correlated with disease-specific survival on univariate anal ysis, only patient age (P = 0.042) and stage (P = 0.0001) were signifi cant on multivariate analysis with the type of surgical procedure perf ormed approaching significance (P = 0.0504). Conclusions. Primary tumo r stage and surgical procedure performed (radical versus parenchymal s paring) are important predictors of disease recurrence. Patient age an d tumor stage were the only predictors of disease-specific survival on multivariate analysis with the type of surgical procedure approaching significance. Radical nephroureterectomy achieves excellent local con trol even in the setting of locally advanced (pT3 or T4) disease. The major clinical feature in this setting is distant failure, and the dev elopment of effective systemic therapy is needed to improve the outcom e in these patients. UROLOGY 52: 594-601, 1998. (C) 1998, Elsevier Sci ence Inc. All rights reserved.