Survival Following Kidney Sparing Management of Upper Urinary Tract Transitional Cell Carcinoma is Adversely Affected By Prior History of Bladder Cancer

Abstract

Objective: To evaluate oncological outcomes of Kidney Sparing Surgery (KSS) for upper urinary tract transitional cell carcinoma (UUT-TCC). Patients and Methods: We performed a retrospective review of patients who underwent segmental ureterectomy or endoscopic treatment (percutaneous nephroscopy or retrograde ureteroscopy) for UUT-TCC between 1991 and 2006 at our institution. We evaluated recurrence-free and overall survival rates following KSS. There were 40 renal units in 38 patients. Three patients had bilateral synchronous disease. Mean patient age (±SD) was 69.8±12.3 years. Eighteen (47%) patients had a prior history of bladder TCC. Sixteen (40%) segmental ureterectomies and 24 (60%) endoscopic treatments were performed. Six (16%) patients received adjuvant BCG. Grade distribution was 24 (60%) low-grade, 12 (30%) high-grade and 4 (10%) Gx. The mean follow-up was 47 months. Results: Recurrence rate was 32.5%. The three and five-year recurrence-free survivals were 59.5% and 42.4%. Tumor location was predictive for recurrence (p <0.03). The three and five-year overall survivals were 91.6% and 79.8%. Predictive variables for overall survival were tumor grade (p <0.008) and stage (p <0.018) and previous history of bladder TCC. There was a statistically significant correlation (r= 0.3539) between tumor grade and stage (p= 0.027). Conclusions: KSS offers good oncological outcomes in selected patients with UUT-TCC. The tumor biology rather than the surgical approach dictates prognosis. Patients with higher stage and grade disease may be better served with a more aggressive treatment approach.

Key Words: Upper Urinary Tract, Transitional Cell Carcinoma, Endoscopic, Kidney Sparing Surgery, Ureteroscopy, Percutaneous, Survival, Recurrence