[en] To assess the prognostic factors in patients with transitional-cell carcinoma of the renal pelvis and/or ureter, a series of 138 patients with transitional-cell carcinoma of the renal pelvis and/or ureter was collected in a retrospective multicentre study. 12 patients with distant metastases were excluded from the statistical evaluation. All but 3 patients underwent radical surgery: nephroureterectomy (n=71), nephroureterectomy and lymphadenectomy (n=20), nephroureterectomy and partial bladder resection or transurethral resection (n=20), nephrectomy (n=10), and ureterectomy (n=5). Sixty-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, residual tumour was still present in 33 patients (16 microscopic and 17 macroscopic). 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 patients. In univariate analyses, statistically significant factors influencing the outcome were Karnofsky index, pT-classification, pN-classification, tumour localisation, grade, and residual tumour after surgery. Multivariate analysis revealed that independent prognostic factors influencing outcome were pT-classification, the existence of residual tumour, and tumour localisation. In patients with urothelial renal pelvis and/or ureter tumours, a radical surgical attitude is mandatory; and the presence of tumour in the ureter is associated with a poorer prognosis.
Disciplines :
Hematology Oncology
Author, co-author :
Ozsahin, M; Centre Hospitalier Universitaire Vaudois (CHUV) > Radiation Oncology > Bugnon 46, 1011, Lausanne, SUISSE
Reitelman C., Sawczuk I.S., Olsson C.A., Puchner P.J., Benson M.C. Prognostic variables in patients with transitional cell carcinoma of the renal pelvis and proximal ureter. J. Urol. 138:1987;1144-1145.
Freiha F.S. Renal, renal pelvis and ureteral tumours: should retroperitoneal nodes be treated? Front. Radiat. Ther. Oncol. 28:1994;155-163.
Babaian R.J., Johnson D.E., Chan R.C. Combination nephroureterectomy and postoperative radiotherapy for infiltrative ureteral carcinoma. Int. J. Radiat. Oncol. Biol. Phys. 6:1980;1229-1232.
Brookland R.K., Richter M.P. The postoperative irradiation of transitional cell carcinoma of the renal pelvis and ureter. J. Urol. 133:1985;952-955.
Brady L.W., Gislason G.J., Faust D.S., Kazem I., Antoniades J., Davis J.A. Radiation therapy: a valuable adjunct in the management of carcinoma of the ureter. J. Am. Med. Assoc. 206:1968;2871-2874.
Cozad S.C., Smalley S.R., Austenfeld M., Noble M., Jennings S., Raymond R. Transitional cell carcinoma of the renal pelvis or ureter: patterns of failure. Urology. 46:1995;796-800.
Maulard-Durdux C., Dufour B., Hennequin C., et al. Postoperative radiation therapy in 26 patients with invasive transitional cell carcinoma of the upper urinary tract: no impact on survival? J. Urol. 155:1996;115-117.
Sobin LH, Wittekind C. TNM Classification of Malignant Tumours. New York, Wiley-Liss, 1997, 183-186.
Kaplan E.L., Meier P. Nonparametric estimation from incomplete observations. J. Am. Stat. Assoc. 53:1958;457-481.
Peto P., Pike M.C., Armitage P., et al. Design and analysis of randomised clinical trials requiring prolonged observation of each patient: Part II. Br. J. Cancer. 35:1977;1-39.
Beck-Bornholdt H.P., Dubben H.H. Potential pitfalls in the use of P-values and in interpretation of significance levels. Radiother. Oncol. 33:1994;171-176.
Cox D.R. Regression models and life tables. J. Roy. Stat. Soc. 34:1972;187-220.
Blacher E.J., Johnson D.E., Abdul-Karim F.W., Ayala A.G. Squamous cell carcinoma of the renal pelvis. Urology. 25:1985;124-126.
Heney N.M., Nocks B.N., Daly J.J., Blitzer P.H., Parkhurst E.C. Prognostic factors in carcinoma of the ureter. J. Urol. 125:1981;632-636.
Corrado F., Ferri C., Mannini D., et al. Transitional cell carcinoma of the upper urinary tract: evaluation of prognostic factors by histopathology and flow cytometric analysis. J. Urol. 145:1991;1159-1163.
Huben R.P., Mounzer A.M., Murphy G.P. Tumour grade and stage as prognostic variables in upper tract urothelial tumours. Cancer. 62:1988;2016-2020.
Charbit L., Gendreau M.C., Mee S., Cukier J. Tumours of the upper urinary tract: ten years of experience. J. Urol. 146:1991;1243-1246.
Buckley J.A., Urban B.A., Soyer P., Scherrer A., Fishman E.K. Transitional cell carcinoma of the renal pelvis: a retrospective look at CT staging with pathologic correlation. Radiology. 201:1996;194-198.
Chiang P.H., Huang M.S., Tsai C.J., Tsai E.M., Huang C.H., Chiang C.P. Transitional cell carcinoma of the renal pelvis and ureter in Taiwan: DNA analysis by flow cytometry. Cancer. 71:1993;3988-3992.
Loehrer P.J., Einhorn L.H., Elson P.J., et al. A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. J. Clin. Oncol. 10:1992;1066-1073.
Sternberg C.N., Yagoda A., Scher H.I., et al. Methotrexate, vinblastine, doxorubicin and cisplatin for advanced transitional cell carcinoma of the urothelium. Cancer. 64:1989;2448-2458.