Prognostic value of ureteral location of upper tract urinary carcinoma (Lynch Syndrome patients)

Blogger's Note/Opinion: urothelial carcinoma of the ureter is a rare carcinoma but is part of the Lynch Syndome spectrum of cancers; most specifically it is not an uncommon cancer in Syndrome patients albeit the research is very lacking;  this study is not specific to Lynch Syndrome patients but is critically important on the treatment/outcomes of patients determined by the location of the tumor in the ureter (typically one-sided in Lynch Syndrome patients - per research known to date); urothelial (ureter/renal pelvis - given stage, grade, surgery etc) can and does spread/recur/new primary in the bladder

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Abstract

 OBJECTIVES:
The aim of this study was to evaluate the prognostic significance of the ureteral location of the upper tract urinary carcinoma (UTUC).

PATIENTS AND METHODS:

Between January 1998 and December 2007, 161 patients with UTUC were operated in our center. Tumors were located on renal pelvis in 51% of cases, on the ureter in 34% of cases and in both locations in 15% of cases. Nephroureterectomy (surgical removal of kidney, renal pelvis and ureter) was performed in 79.5% of cases (128/161) whereas a conservative treatment was performed in 20.5% of cases (33/161).

RESULTS:

In our series, 29.8% of patients had primary bladder cancer and 14.3% had synchronous bladder tumor. At a median follow-up of 42.5 months, 38.6% of patients developed bladder recurrence and 4.8% developed controlateral upper tract tumor. In multivariate analysis, ureteral location and existence of synchronous bladder tumor were independent prognostic factors of bladder recurrence (P=0.009 and P=0.025, respectively). Multivariate analysis retained T-stage and ureteral location as independent prognostic factors in both overall and disease-free survival (P=0.002 and P=0.0008 respectively for ureteral location).

CONCLUSION:

Ureteral location was an independent prognostic factor of bladder recurrence and was associated with a poorer prognosis.