Endoscopic Management of Upper Tract Transitional Cell Carcinoma in Patients with Normal Contralateral Kidneys

Abstract

We report our experience using ureteroscopic or percutaneous management of upper tract transitional cell carcinoma (TCC) in elective situations. Between 1983 and 2004 we identified 83 patients who underwent endoscopic management of upper tract TCC in the setting of a normal contralateral kidney. We performed a retrospective chart review and conducted outcome analyses. Median age at diagnosis was 71 years (range, 37 to 90 years) and median tumor size was 0.8 cm (range, 0.2 to 3.0 cm). Grade 3 tumors were present in 8 patients (10%), whereas the remaining 75 (90%) patients were grade 1 or 2 or diagnosed as visual low grade. Tumor stage was Ta or visual Ta in 78 patients (94%). Median follow-up was 4.6 years (range, 0.4 to 17 years) during which 46 patients (55%) developed 76 upper tract recurrences and 37 patients (45%) developed a recurrence in the bladder. At last follow-up, 27 patients (33%) required a nephroureterectomy and 9 patients (11%) died from TCC. Patients with high-grade (risk ratio, 9.8; P = 0.001) and non-Ta stage tumors (risk ratio, 5.7; P = 0.003) were at significant risk of death from disease. Among 43 patients with a diagnosis based on visual inspection only, 9 (21%) developed grade 3 TCC during follow-up. Our results underscore the need for strict surveillance after endoscopic management of upper tract TCC. Recurrence is common and nearly one-third of patients in this cohort eventually required nephroureterectomy. Patients with a visual diagnosis, without adequate tissue for pathologic analysis, can experience recurrence of high-grade invasive TCC.