Prognostic factors in urothelial renal pelvis and ureter tumours: a multicentre rare cancer network study

To assess the prognostic factors in patients with transitional-cell carcino ma of the renal pelvis and/or ureter, a series of 138 patients with transit ional-cell carcinoma of the renal pelvis and/or ureter was collected in a r etrospective multicentre study. 12 patients with distant metastases were ex cluded from the statistical evaluation. All but 3 patients underwent radica l surgery: nephroureterectomy (n = 71), nephroureterectomy and lymphadenect omy (n = 20), nephroureterectomy and partial bladder resection or transuret hral resection (n = 20), nephrectomy (n = 10), and ureterectomy (n = 5). Si xty-one per cent (n = 77) of the tumours were located in the renal pelvis, and 21% (n = 27) in the ureter (both in 22 [17%]). Following surgery, resid ual tumour was still present in 33 patients (16 microscopic and 17 macrosco pic). Postoperative radiotherapy was given to 45 (36%) patients. The median follow-up period was 39 months. In a median period of 9 months, 66% of the patients relapsed (34 local, 7 locoregional, 16 regional, and 24 distant). The 5- and 10-year survival were 29% and 19%, respectively, in all patient s. In univariate analyses, statistically significant factors influencing th e outcome were Karnofsky index, pT-classification, pN-classification, tumou r localisation, grade, and residual tumour after surgery. Multivariate anal ysis revealed that independent prognostic factors influencing outcome were pT-classification, the existence of residual tumour, and tumour localisatio n. In patients with urothelial renal pelvis and/or ureter tumours, a radica l surgical attitude is mandatory; and the presence of tumour in the ureter is associated with a poorer prognosis. (C) 1999 Elsevier Science Ltd. All r ights reserved.