상부요로 이행세포암의 재발 양상 및 예후 인자

Abstract

Purpose: We evaluated the pattern of recurrence and the prognostic factors for patients who suffered with upper urinary tract transitional cell carcinoma (TCCa) and were surgically treated.

Materials and Methods: Between 1986 and 2003, the medical records on 228 patients who were diagnosed and surgically treated for upper urinary tract TCCa were retrospectively analyzed with regard to the pattern of recurrence and the prognostic factors. The main site of the tumors was the renal pelvis in 127 patients and the ureter in 101 patients. Nephroureterectomy and/or bladder cuff resection was performed on 215 patients and conservative surgery was performed on 13 patients, respectively.

Results: Recurrence developed in 75 patients (32.9%) and the mean time to recurrence was 23.9 months (3-120). Of these 75 patients, locoregional recurrence without metastasis occurred in 28.0%, locoregional recurrence with metastasis occurred in 25.3%, metastasis without locoregional recurrence occurred in 42.7% and contralateral upper tract recurrence occurred in 4%. There was no difference between the renal pelvic cancer and ureteral cancer regarding the pattern of recurrence. Meanwhile, 5-year recurrence-free and disease-specific survival rates were 63.9% and 69.7%, respectively. On univariate analysis, the T stage, tumor grade, lymphovascular permeation, margin status and nodal status had a significant influence on recurrence-free survival and disease-specific survival. On multivariate analysis, the T stage and lymphovascular permeation were independent prognostic factors for upper urinary tract TCCa.

Conclusions: Locoregional recurrence and metastasis frequently occurred in the upper urinary tract TCCa irrespective of the tumor location. The T stage and lymphovascular permeation were independent prognostic factors for the upper urinary tract TCCa.