Study documents features, outcomes of upper tract TCC

August 1, 2007

The primary message from a study evaluating long-term urothelial recurrence and disease-specific survival after radical nephroureterectomy for upper tract transitional cell carcinoma is that there remains a critical need for better methods to enable early diagnosis.

Anaheim, CA-The primary message from a study evaluating long-term urothelial recurrence and disease-specific survival after radical nephroureterectomy for upper tract transitional cell carcinoma is that there remains a critical need for better methods to enable early diagnosis, the study's authors said at the AUA annual meeting.

Cox regression analyses were performed to analyze independent prognostic factors for urothelial recurrence and disease-specific survival. The results contained no surprises. Urothelial recurrence after radical surgery was found to be significantly predicted by previous TCC (p=.05). Independent prognostic factors for disease-specific survival were identified as being pathologic tumor stage (p=.0186) and grade (p<.0001).

"Our study reinforces what is already well known, and that is the identification of better methods for early diagnosis of upper tract TCC remains a research challenge for the future. Hopefully, success in that area, along with the advent of new complementary systemic treatment strategies for high-risk tumors, will translate into improved outcomes for patients with upper tract TCC," said Christian Bolenz, MD, of the department of urology at University Hospital, who worked on the study with first author Mario Fernández, MD, of Clínica Alemana, Santiago, Chile, when Dr. Fernández spent a scholarship year in Mannheim.

One of few large series

Because upper tract TCC is a rare tumor, there is a paucity of published information on outcomes after radical surgery based on follow-up of large patient series. Having accrued a relatively large cohort of patients operated on for the disease over 2 decades with few lost to follow-up, the investigators were hoping to add to the existing literature with an analysis of outcomes and prognostic factors.

"To our knowledge, ours is one of the few large series evaluating prognostic factors in upper tract TCC after nephroureterectomy," Dr. Bolenz said.

Aside from history of TCC and pathologic tumor stage and grade, the variables analyzed as possible outcome predictors included patient age, tumor multifocality, tumor size, tumor localization, and urothelial recurrence (disease-specific survival only). Tumor multifocality was present in 28 patients (19.3%), and in univariate analysis, it showed a trend toward having predictive value for urothelial recurrence. However, that feature was not associated with recurrence in the multivariate analysis.

Overall, the group was composed of about two-thirds men, with a median age of almost 70 years. Fifty-two patients (36.7%) had a history of TCC; more than three-fourths of those patients had bladder tumors, while almost 8% had a TCC in the bladder and upper urinary tract.

The primary tumor for the current analysis was located in the renal pelvis in 65% of patients, in the ureter in 20%, and in both the ureter and renal pelvis in the rest. A small proportion of patients, 6%, had concomitant bladder TCC.

The authors observed that within the series, about 20 of the most recent patients were operated on with a laparoscopic approach. All other surgeries were open procedures.

"To date, we have not found that laparoscopic nephroureterectomy adversely affects outcome for patients with upper tract TCC. However, follow-up time is rather short, and this has to be proven in the future," Dr. Bolenz told Urology Times.