Tumor grade and stage as prognostic variables in upper tract urothelial tumors

Abstract

Clinical and pathologic data of 54 patients with clinically localized transitional cell tumors of the upper urinary tract were reviewed to determine the significance of tumor grade and stage on patient survival. There were 43 tumors of the renal pelvis (one bilateral) and 11 tumors of the ureter. The primary tumor was staged by the new TNM classification into low stage (Ta: limited to mucosa; TI: lamina propria invasion) and high stage (Tz: muscularis invasion; TJ; invasion beyond the muscularis). Tumors were low stage (T./TI) in 28 cases (51.8%) and advanced (Tz/TJ) in 26 cases (48.2%). Twenty-five of 54 (46.3%) of the patients had low grade (Grades 1 and 2) and 29 of 54 (53.7%) had high grade (Grades 3 and 4) tumors. Median survival for all patients from date of diagnosis was 31 months, with a 5-year survival rate of 45.8%. Grade (low/high) matched stage (low/high) in 45 of 54 patients (83%). Median survival for patients with low grade tumors was 66.8 months compared to 14.1 months in patients with high grade tumors. Median survival for low stage tumors was 91.1 months and for high stage tumors was 12.9 months. These differences in survival related to both tumor stage (P = 0.001) and grade (P = 0.004) were statistically significant by log-rank test. Fourteen of the 54 patients (25.9%) developed local recurrence and 29 (53.7%) developed distant metastases. The lung was the most common site of metastasis. Eighteen patients (33.3%) had or developed transitional cell carcinoma of the bladder, which preceded the diagnosis of transitional cell carcinoma of the upper tract in seven cases and developed subsequently in 11 cases. Primary tumor stage by the new TNM classification is a better predictor of prognosis than tumor grade, although both variables are strongly predictive of patient course and survival. The advantages of the new TNM classification are discussed. Cancer 62:2016-2020, 1988. RANSITIONAL CELL carcinoma of the upper urinary T tract is an uncommon disease, accounting for 4.5% to 9% of all renal tumors and 5% to 6% of all urothelial tumors.'-5 Tumors of the renal pelvis are more common than ureteral tumors by a ratio of 3: 1 or 4: 1 .637 The incidence of bilateral synchronous occurrence of upper tract tumors is approximately 1.5% to 2%, and the incidence of asynchronous bilateral development is 6% to 8%.s38 The incidence of subsequent development of bladder tumors in patients with tumors of the renal pelvis or ureter varies between 20% and 30%.6,7 The incidence of ipsilateral recurrence varies between 6% for low grade tumors to 28% to 43% for high grade tumors.9-" There is usually a good correlation between grade and stage of upper tract rumors and subsequent progno~is.~-~ Herein all cases of transitional cell carcinoma of the

Trends in epidemiology and treatment of upper urinary tract tumours in the Netherlands 1995–2005: an analysis of PALGA, the Dutch national histopathology registry

“…As in other clinical series, most tumours in the present study were grade 2 or 3 and stage Ta, T1 or T3 [6][7][8][9]. Moreover, there was a statistically significant increase in grade 3 and muscle invasive tumours.…”

“…Data on distribution of stage and grade at initial presentation indicate that most patients present with a low stage (Ta-T1) grade 2 or 3 tumour [1,[6][7][8][9]. Stage and grade are the most important prognostic factors for recurrence and survival [7][8][9][10][11], but type of treatment [7] and multifocality [8,12], have also been reported to be important, to a variable extent.…”

pT classification, grade, and vascular invasion as prognostic indicators in urothelial carcinoma of the upper urinary tract

“…2,8,11,12,[14][15][16][17][18][20][21][22][23][24][25]29,[32][33][34] Thus, the identification of independent prognostic variables is an essential step to predict disease evolution, thus aiding surveillance strategies, and also to identify patient subgroups that might benefit from adjuvant cancer therapy. Our study is by far the largest systematic investigation of the impact of pT classification, tumor grade, as well as vascular invasion in patients with both pelvic and ureteral UCs with respect to metastasis-free survival.…”

Expression of Hypoxia-Inducible Factor-1α Protein Predicts Survival in Patients with Transitional Cell Carcinoma of the Upper Urinary Tract

“…Although the prognostic significance has been established for both stage and grade (39,40), it is important to identify prognostic markers that will predict which patients are likely to have disease progression. Patients who have a subsequent intravesical recurrence can be treated with more effective adjuvant therapy.…”