Are urothelial carcinomas of the upper urinary tract a distinct entity from urothelial carcinomas of the urinary bladder? Behavior of urothelial carcinoma after radical surgery with respect to anatomical location: a case control study.

Myong Kim,Cheol Kwak,Chang Wook Jeong,Hyeon Hoe Kim,Ja Hyeon Ku

doi:10.1186/s12885-015-1161-9

Myong Kim, Cheol Kwak + Show 3 more

Open Access

https://doi.org/10.1186/s12885-015-1161-9

Copy DOI

Journal: BMC cancer	Publication Date: Mar 18, 2015
Citations: 41	License type: CC BY 4.0

Affiliation: Seoul National University

Abstract

BackgroundTo compare the prognosis of upper urinary tract (UUT)-urothelial carcinoma (UC) and UC of the bladder (UCB) by pathological staging in patients treated with radical surgeries.MethodsThe study population comprised 335 and 302 consecutive radical surgery cases performed between 1991 and 2010 for UUT-UC and UCB, respectively. Five-year recurrence-free survival (RFS) and cancer-specific survival (CSS) rates were analyzed. The median follow-up period of all subjects was 59.3 months (range, 0.1–261.0 months).ResultsNo difference was observed in median patient age, distribution of pathologic T stage, or rates of positive surgical margin between the two groups. The UUT-UC group had significantly more frequent hydronephrosis than the USB group (48.1% vs. 20.2%, p < 0.001). However, the UUT-UC group showed significantly less frequent grade III tumors (28.1% vs. 58.6%, p < 0.001), lymphovascular invasion (18.8% vs. 35.8%, p < 0.001), and associated carcinoma in situ (9.0% vs. 21.9%, p < 0.001) than the UCB group. Five year RFS rates in the UUT-UC and UCB groups were 77.0% and 75.9%, respectively (p = 0.546). No significant difference in RFS rate was observed between pathological T stage subgroups. Five year CSS rates in the UUT-UC and UCB groups were 76.1% and 76.2%, respectively (p = 0.462). No significant difference was observed in CSS rate between the pathologic T stage subgroups.ConclusionsUUT-UC and UCB showed comparable prognosis at identical stages. However, our results should be verified in a prospective study due to the retrospective study design in this study.

Highlights

To compare the prognosis of upper urinary tract (UUT)-urothelial carcinoma (UC) and UC of the bladder (UCB) by pathological staging in patients treated with radical surgeries
No difference in median age or pathologic T stage distribution was observed between the two groups
Due to the relative preponderance of UCB, much of the clinical decision making regarding UUT-UC is extrapolated from evidence gained on UCB

Summary

Introduction

To compare the prognosis of upper urinary tract (UUT)-urothelial carcinoma (UC) and UC of the bladder (UCB) by pathological staging in patients treated with radical surgeries. Urothelial carcinoma (UC) is the fourth most common tumor in the United States and Europe, representing a heterogeneous groups of cancers [1]. Upper urinary tract (UUT)-UC represents 5% of UC at the initial diagnosis [2]. The two types of UC share common pathogenic mechanisms. They are expected to show analogous tumor characteristics [5] with similar prognostic risk factors [6,7]. Pathological staging of the two types of tumors is based identically on the natural anatomy of the UUT and the bladder, there have been some concerns that UUT may be more vulnerable to tumor spreading compared to that of the urinary bladder.

Methods

Results

Discussion

Conclusion