The Impact of Tumor Location on Prognosis of Transitional Cell Carcinoma of the Upper Urinary Tract

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Abstract
We assessed the impact of traditional prognostic factors and tumor location on the survival of patients treated for upper tract transitional cell carcinoma (TCC). We retrospectively analyzed the data on 86 patients with upper tract TCC who underwent nephroureterectomy with a bladder cuff (95%) or parenchymal sparing surgery (5%). Mean patient age was 59.5 years and median followup was 43.8 months. The influence of traditional prognostic factors such as age, gender, tumor stage, grade and location on 5-year disease specific and recurrence-free (local recurrence or distant metastasis) survival rates was analyzed. The difference in survival rates between renal 45 pelvis and 41 ureteral cases was analyzed according to the respective T stage and grade. Overall 5-year disease specific and recurrence-free survival rates were 83% and 72%, respectively. The significant prognostic factors for survival rates by univariate analysis were T stage, grade and location. N stage was significant for 5-year recurrence-free survival. On multivariate analysis tumor location was the only independent prognostic factor for the 2 survival rates, while N stage was significant for 5-year recurrence-free survival. Patients with ureteral tumor had a worse prognosis than those with pelvis tumor at the same stage or grade (p = 0.036). Pelvis and ureteral TCC are not the same disease in terms of invasion and prognosis. Ureteral TCC is associated with a higher local or distant failure rate than renal pelvis TCC. A radical surgical approach including meticulous lymphadenectomy may be therapeutic in patients with invasive ureteral TCC.