DOI: http://dx.doi.org/10.18203/2349-2902.isj20183206

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

Bhavin Patel, Ravi Batra, Maneshwar Singh Utaal, Pooja Batra

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.


Keywords


Distal ureteric tumors, Renal pelvic tumors, Radical nephroureterectomy, Urothelial carcinoma of upper urinary tract

Full Text:

PDF

References


Munoz JJ, Ellison LM. Upper tract urothelial neoplasms: incidence and survival during the last 2 decades. J Urol. 2000;164(5):1523-5.

Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007;57:43-66.

Markovic B. Endemic nephritis and urinary tract cancer in Yugoslavia, Bulgaria and Rumania. J Urol. 1972;107:212-9.

Acher P, Kiela G, Thomas K, O’Brien T. Towards a rational strategy for the surveillance of patients with Lynch syndrome (hereditary non-polyposis colon cancer) for upper tract transitional cell carcinoma. BJU Int. 2010;106(3):300-2.

Batata MA, Grabstald H. Upper Urinary Tract Urothelial Tumors. Urol Clin North Am. 1976;3:79-86.

Li WM, Shen JT, Li CC, et al. Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma. Eur Urol. 2010;57(6):963-9.

Babjuk M, Oosterlinck W, Sylvester R, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder. Eur Urol. 2008;54(2):303-14.

Booth CM, Cameron KM, Pugh RCB. Urothelial carcinoma of the kidney and ureter. Br J Urol. 1980;52:430-5.

Melamed MR, Reuter VE. Pathology and staging of urothelial tumors of the kidney and ureter. Urol Clin North Am.1993;20:333-47.

Bonsib SM. Pathology of the renal pelvis and ureter. In: Eble JN, ed. Tumors and Tumor-like Conditions of the Kidneys and Ureters. New York, NY: Churchill Livingstone;1990:177-202.

Radhakrishnan S, Aga P, Jain M, Srivastava A, Kapoor R, Mandhani A. Clinicopathological spectrum and the outcome of treatment of upper tract transitional cell carcinoma. Indian J Urol. 2012;28:174-8.

Novara G, Marco V, Gottardo F, et al. Independent predictors of cancer specific survival in transitional cell carcinoma of the upper urinary tract: multi-institutional dataset from 3 European centres. Cancer. 2007;110:1715-22.

Brown GA, Busby JE, Wood CG, Pisters LL, Dinney CP, Swanson DA, et al. Nephroureterectomy for treating upper urinary tract transitional cell carcinoma: time to change the treatment paradigm? BJU Int. 2006;98:1176-80.

Say CC, Hori JM. Transitional cell carcinoma of the renal pelvis: experience from 1940 to 1972 and literature review. J Urol. 1974;112:438-42.

Raman JD, Shariat SF, Karakiewicz PI, Lotan Y, Sagalowsky AI, Roscigno M, et al. Does preoperative symptom classification impact prognosis in patients with clinically localized upper tract urothelial tumors managed by radical nephroureterectomy? Urol Oncol. 2011;29(6):716-23.

Bloom NA, Vidone RA, Lytton B. Primary carcinoma of the ureter: A report of 102 new cases. J Urol. 1970;103:590-8.

Phé V, Cussenot O, Bitker MO, Rouprêt M. Does the surgical technique for management of the distal ureter influence the outcome after nephroureterectomy? BJU international. 2011;108(1):130-8.

Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer 2009;115(6):1224-33.

Fernández MI, Shariat SF, Margulis V, Bolenz C, Montorsi F, Suardi N. Evidence-based sex related outcomes after radical nephrouretertectomy for upper tract urothelial carcinomas: Results of large multicentre study. Urol. 2009;73:142-6.

Li WM, Li CC, Ke HL, Wu WJ, Huang CN, Huang CH. The Prognostic Predictors of Primary Ureteral Transitional Cell Carcinoma After Radical Nephroureterectomy. J Urol. 2009;182:451-8.

Abouassaly R, Alibaba SM, Shah N, Timilshina N, Fleshner N, Finelli A. Troubling Outcomes From Population-level Analysis of Surgery for Upper Tract Urothelial Carcinoma. Urol. 2010;76:895-901.

Hasui Y, Nishi S, Kitada S, Osada Y, Asada Y. The prognostic significance of vascular invasion in upper urinary tract transitional cell carcinoma. J Urol. 1992;148:1783-5.

Kikuchi E, Margulis V, Karakiewicz PI, Roscigno M, Mikami S, Lotan Y, et al. Lymphovascular invasion predicts clinical outcomes in patients with node negative upper tract urothelial carcinoma. J Clin Oncol. 2009;27:612-18.

Langer C, Hutterer G, Chromecki T, Leibl S, Rehak P. Tumor Necrosis as Prognostic Indicator in Transitional Cell Carcinoma of the Upper Urinary Tract J Urol. 2006;176:910-4.

Roscigno M, Shariat SF, Margulis V, Karakiewicz P, Remzi M, Kikuchi E, et al. The extent of lymphadenectomy seems to be associated with better survival in patients with nonmetastatic upper-tract urothelial carcinoma: how many lymph nodes should be removed? Eur Urol. 2009;56(3):512-8.

Gill IS, Sung GT, Hobart MG, Savage SJ, Meraney AM, Schweizer DK, et al. Laparoscopic radical nephrourerectomy for upper tract transitional cell carcinoma: the Cleveland Clinic experience. J Urol 2000;164:1513-22.

Manabe D, Saika T, Ebara S, Uehara S, Nagai A, Fujita R, et al. Okayama Urological Research Group, Okayama. Japan. Comparative study of oncologic outcome of laparoscopic nephroureterectomy and the standard nephroureterectomy for upper tract transitional cell carcinoma. Urol. 2007;69:457-61.

Shalhav AL, Dunn MD, Portis AJ, Elbahnasy AM, McDougall EM, Clayman RV. Laparoscopic nephroureterectomy for upper tract transitional cell cancer: the Washington University experience. J Urol. 2000;163:1100-4.