Upper tract transitional cell carcinoma following cystectomy for bladder cancer

Purpose.-We, assessed the incidence of upper urinary tract tumors (UUTTs) a fter cystectomy for invasive or superficial transitional cell carcinoma (TC C) of the bladder. The risk factors, patients' characteristics and evolutio n of those who developed UUTTs are analyzed. Materials and Methods. From August 1980 to February 1994,568 radical cystec tomies were performed for TCC of the bl adder: in 469 instances (82.5%) due to invasive tumor (T2-T4), and in 99, cases (17.5%), for superficial! tumo r (Ta,T1,Tis). All patients were followed for at least 5 years, or until de aths. A retrospective study of patients who developed UUTTs has been perfor med. A revision of bladder tumor and UUTT characteristics, and the interval s between both is also evaluated. Results: 26 patients (4.5%), developed UUTTs: 11 of the 99 patients cystect omized for superficial TCCs (11.1%); 6 of the 392 patients with primary inv asive TCC (1.5%), and 9 of the 77 (11.6%) patients with invasive tumors and a prior history of superficial TCC. The interval to the development of UUT T was higher after cystectomy for superficial tumor. TCCs of the bladder th at subsequently developed UUTTs were high grade in 84%, multifocal in 80%, or had carcinoma in situ in 65%, tumor in the prostatic urethra in 52%, and involvement of the distal ureter in 57%. Twenty-two UUTTs (84%) were locat ed in the calyces or the renal pelvis, 3 were bilateral (11.5%), 14 multipl e (58%) and 4 superficial (16%). With a median follow-up time of 18 (range 3-103) months, 14 patients (53.8%) died of tumor, 2 were alive with disease , 2 were lost for follow-up, and 8 (30%) were alive and free of disease. Conclusions:We found that patients cystectomized for superficial or invasiv e TCC with a prior history of superficial TCC have a higher incidence of UU TTs. These cases require follow-up with: annual urography or loopography. C opyright (C) 2001 S. Karger AG, Basel.