Management of High Grade Transitional Cell Cancer of the Upper Urinary Tract

Abstract

A total of 175 patients was operated on for grade 2, 3 or 4 transitional cell epithelioma of the upper urinary tract. Follow-up was between 5 and 26 yr. The operations involved total nephroureterectomy, simple nephrectomy and local resection. Patient survival correlated well with tumor stage and, particularly, with tumor grade, and consistently was inferior to that of an age- and sex-matched control group. The correlation of survival and ipsilateral tumor recurrence with the type of operation suggests that patients with grade 2 tumors may benefit from total nephroureterectomy. The incidence of ipsilateral tumor recurrence (28%) was high in this group. The radical procedure seems to be of no benefit to patients with grade 3 or 4 tumors. The incidence of subsequent bladder tumor was 30% in patients with grades 2 and 3 tumors. The latent period ranged from 2 mo. to 10 yr (average 23 mo.); 82% of the tumors occurred within 3 yr of treatment of the upper tract tumor.