Clinico-pathological profile of patients with upper tract TCC: a single centre experience

Abstract

Background: Urothelial carcinomas are rare tumors and this rarity have made these tumors greatly significant. Urothelial Carcinoma of Upper Urinary Tract (UC-UUT) are still rarer and occur in elderly population. Much of the literature concerning urothelial neoplasms has focused on the urinary bladder, which is understandable given that the majority of these tumors occur in the bladder. Most common UC-UUT are the renal pelvic tumors followed by distal ureteric tumors. There is paucity of literature of UC-UUT in the Indian context hence this study assumes importance.Methods: 16 cases of UC-UUT were included in the study. A complete preoperative evaluation was done. Radical Nephroureterectomy (RNU) with bladder cuff excision was undertaken and histopathology of resected specimen was noted. Adjuvant therapy was given wherever necessary. A systematic follow-up was done, and recurrences were noted and treated. Data was then analyzed.Results: Male to female ratio was 3:1. Most patients presented with hematuria. Most lesions were left sided. Renal pelvis was the most affected site.73% tumors were of high grade and 47% were in pT3 stage. There was a single case of systemic metastasis in present study.15 out of 16 cases underwent radical nephroureterectomy with bladder cuff excision. In follow up, recurrence free survival was 66.67% and cancer free survival was 86.6% after surgery.Conclusions: Upper urinary tract urothelial tumor is a rare disease In Indian context, majority of patients presented late and were having high stage and grade at the time of diagnosis. Invasive disease was more common. Radical nephroureterectomy in still the gold standard treatment. Conservative treatment should be considered in specific cases. Recurrences in bladder are common and should be treated early.