M. Morioka et al., Prognostic factors for survival and bladder recurrence in transitional cell carcinoma of the upper urinary tract, INT J UROL, 8(7), 2001, pp. 366-373
Background: Prognostic factors for survival in transitional cell carcinoma
of the upper urinary tract have been extensively evaluated, but detailed an
alyses of patterns of bladder recurrence after surgery have been rare.
Methods: The outcome and tumor recurrence of 93 patients with transitional
cell carcinoma of the upper urinary tract surgically treated between 1975 a
nd 1999 were reviewed, retrospectively. Disease-specific survival by pathol
ogic stage and grade were analyzed by the Kaplan-Meier method. Prognostic f
actors for survival and bladder recurrence were examined by univariate and
multivariate analysis.
Results: The 5-year disease-specific survival rates of the patients with pT
a. T1 and T2 were 92.9%, 100% and 88.9%, respectively. However, that of the
pT3 patients was 61.9% and the median survival of the pT4 cases was only 7
months. Bladder recurrence was seen in 40 cases and recurrences occurred w
ithin 1 year in 32 of these patients. The stage and grade of metachronous b
ladder tumors usually resembled those of primary tumors, but invasive recur
rences were seen in 19% of recurrent cases with primary pTa, pT1 tumors. Th
e significant prognostic factor for survival was pathologic stage (pT3, pT4
), but no significant variables were detected for bladder recurrence by mul
tivariate analysis.
Conclusions: The prognosis of pT3, pT4 patients is poor and effective syste
mic adjuvant therapy is necessary. Invasive bladder recurrence occurred in
19% of patients with superficial primary tumors. As no significant prognost
ic variables for bladder recurrence were identified, careful follow up for
bladder recurrence is important even if the primary tumors are non-invasive
.