Articles

Significant Predictive Factors for Prognosis of Primary Upper Urinary Tract Cancer after Radical Nephroureterectomy in Taiwanese Patients

By: Ching-Chia Lia, Tu-Hao Changa, Wen-Jeng Wua lowast , Hung-Lung Kea, Shu-Pin Huangb, Pei-Chien Tsaic, Shun-Jen Changc, Jung-Tsung Shenb, Yii-Her Choua and Chun-Hsiung Huanga

Published online: 01 November 2008

Keywords: Upper urinary tract, Transitional cell carcinoma, Nephroureterectomy, Outcome, Predictive factor, Recurrence, Gender, Taiwan

Abstract Full Text Full Text PDF (247 KB)

Abstract

Objectives

To follow up the long-term prognosis of patients who underwent nephroureterectomy for primary upper urinary tract (UUT) cancer and to evaluate the predictive factors of tumour recurrence and survival.

Methods

Between January 1990 and June 2005, 260 patients with primary UUT transitional cell carcinoma (TCC) underwent radical nephroureterectomy at our institution. The medical records of these patients were retrospectively reviewed. The clinical and histopathological data were analyzed to evaluate predictive factors.

Results

The median follow-up time was 52 mo. In total, 89 patients (34.1%) developed subsequent bladder tumours. Predictive factors of bladder tumour recurrence were being male and having renal insufficiency. Local recurrence developed in 16 patients (6.2%); only the tumour stage was significantly associated with local recurrence. Metachronous contralateral UUT tumour was diagnosed in 12 patients (4.6%), with gender being the only predictive factor. Of the 260 patients, 167 (63.9%) were disease-free and alive at a median follow-up of 56.5 mo, and 45 (17.2%) died of urothelial cancer at a median period of 20 mo. Only the tumour stage was a prognostic factor to predict cancer-specific survival.

Conclusions

In patients with UUT-TCC after radical nephroureterectomy, tumour stage is the only prognostic factor for both local recurrence and cancer-specific survival. Male patients with renal insufficiency should be alerted to the possibility of bladder tumour recurrence. Because female patients were more likely to develop contralateral recurrences, renal ultrasonography, intravenous pyelography, or retrograde pyelography should be performed more frequently for female patients who live in the high-prevalence area.

Take Home Message

We evaluated the predictive factors of tumour recurrence and survival in patients with transitional cell carcinoma of the upper urinary tract after radical nephroureterectomy. Male patients with renal insufficiency should be alert of the possibility of bladder recurrence. Because female patients were more likely to develop contralateral recurrences, renal ultrasonography, intravenous pyelography, or retrograde pyelography should be performed more frequently on females.

Keywords: Upper urinary tract, Transitional cell carcinoma, Nephroureterectomy, Outcome, Predictive factor, Recurrence, Gender, Taiwan.

Footnotes

a Department of Urology, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

b Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

c Department of Pubic Health, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

lowast Corresponding author. Department of Urology, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung 807, Taiwan. Tel. +14 886 7320 8212; Fax: +14 886 7321 1033.