Survival following kidney sparing management of upper urinary tract transitional cell carcinoma is adversely affected by prior history of bladder cancer

Abstract

To evaluate oncological outcomes of Kidney Sparing Surgery (KSS) for upper urinary tract transitional cell carcinoma (UUT-TCC). We performed a retrospective review of patients who underwent segmental ureterectomy or endoscopic treatment (percutaneous nephroscopy or retrograde ureteroscopy) for UUT-TCC between 1991 and 2006 at our institution. We evaluated recurrence-free and overall survival rates following KSS. There were 40 renal units in 38 patients. Three patients had bilateral synchronous disease. Mean patient age (±SD) was 69.8±12.3 years. Eighteen (47%) patients had a prior history of bladder TCC. Sixteen (40%) segmental ureterectomies and 24 (60%) endoscopic treatments were performed. Six (16%) patients received adjuvant BCG. Grade distribution was 24 (60%) low-grade, 12 (30%) high-grade and 4 (10%) Gx. The mean follow-up was 47 months. Recurrence rate was 32.5%. The three and five-year recurrence-free survivals were 59.5% and 42.4%. Tumor location was predictive for recurrence (p<0.03). The three and five-year overall survivals were 91.6% and 79.8%. Predictive variables for overall survival were tumor grade (p<0.008) and stage (p<0.018) and previous history of bladder TCC. There was a statistically significant correlation (r= 0.3539) between tumor grade and stage (p= 0.027). KSS offers good oncological outcomes in selected patients with UUT-TCC. The tumor biology rather than the surgical approach dictates prognosis. Patients with higher stage and grade disease may be better served with a more aggressive treatment approach.