A clinical study of associated bladder cancer in patients with renal pelvic and ureteral cancer]

Retrospective study on the frequency of associated bladder cancer and the influence on the prognosis was carried out in 170 cases of renal pelvic and ureteral cancer. The number of cases of associated bladder cancer coexistent with renal pelvic and ureteral cancer was 31 (18.2%), and the number of subsequent cases 3 (19.4%). The frequency of occurrence of the primary tumor site was 27.2% in the renal pelvis, 45.6% in the ureter and 58.3% in both renal pelvis and ureter. Multiple tumors occurring in the renal pelvis and ureter occupy a high percentage. As for the degree of differentiation, many cases were subsequent to G1. As for the stage, a few cases with bladder cancer were subsequent to T4, but there was no definite tendency in the occurrence of bladder cancer. The prognosis of renal pelvic and ureteral cancer: the 10-year survival rate was 93.3% for G1, 66.6% for G2 and 12.4% for G3. As can be seen, there was good correlation with the pathological gradings. It must be remembered, however, that 5-year survival rates in cases of associated bladder cancer of coexistent type, in cases of subsequent type and in cases without associated bladder cancer were 56.2%, 72.7% and 64.8%, respectively: there was no significant difference. Bladder cancer associated with renal pelvic and ureteral cancer makes the therapy troublesome, but no influence on the prognosis was observed. Therapy in conformity with the pathological grading and stage is regarded as particularly important in cases of associated bladder cancer.     

A clinical survey of renal pelvic and ureteral tumors associated with bladder tumor

A clinical survey was performed on 80 cases of renal pelvic and ureteral transitional cell carcinomas we treated between January, 1963 and December, 1986. The cases included 30 of renal pelvic tumors, 17 of ureteral tumors, 3 of renal pelvic and ureteral tumors, 7 of renal pelvic and ureteral and bladder tumors, 16 of ureteral and bladder tumors and 7 of renal pelvic or ureteral tumors after treatment for bladder tumors. There were 37 cases of bladder tumors: 7 cases with preceding bladder tumors, 23 cases of synchronous bladder tumors, and 13 cases of subsequent bladder tumors. The 5-year survival for all cases was 60.2%. The 5-year survival for 43 cases unrelated with bladder tumors was 80.5% and that for 37 cases of bladder tumor was 41.6%. Therefore, there was a significant difference between these 2 groups (p less than 0.005). The 5-year survival for 50 cases without synchronous bladder tumors at first diagnosis was significantly higher than that for 23 cases with synchronous bladder tumors (p less than 0.001). Subsequent bladder tumors occurred after 2 to 48 months (mean 10 months) of the initial treatment for renal pelvic and ureteral tumors. Six of the 7 cases of preceeding bladder tumors were superficial tumors of pTa and pT1 and 3 cases had vesicoureteral reflux.     

A clinical study of renal pelvic and ureteral cancer

We investigated the clinicopathological features of 52 patients with transitional cell carcinoma of renal pelvic and/or ureter who underwent surgical treatment at Tokyo Medical University Hachioji Medical Center from April, 1992 to June, 2005. The patitents consisted of 38 males and 14 females, ranging from 29 to 86 years old with a median age of 68 years old. The mean follow-up period was 39 months. Pathologicaly, 32 cases were less than pT2 and 20 cases were pT3. Findings of lymphatic and venous invasion were present in 10 and 8 cases, respectively. The infiltration pattern (INF) of gamma was observed in 9 cases. The overall cause-specific survival rate was 95.8% at 1 year, 87.7% at 3 years and 80.6% at 5 years, respectively. According to univariate analysis, the high stage of tumor, the presence of lymphatic and/or venous invasion, the inclusion of infiltration pattern of gamma and positive reginonal lymph nodes indicated a significantly poor prognosis. On the other hand, multivariate analysis using Cox proportional hazards regression revealed the presence of infiltration pattern of gamma as the most significant predictor of survival.     

A clinical study on renal pelvic and ureteral cancer

We investigated the clinicopathological features of 62 patients with transitional cell carcinoma of the renal pelvis and/or ureter who underwent total nephroureterectomy at our department from April, 1987 to October, 2000. The patients consisted of 48 males and 14 females, with a mean age of 67 years, ranging from 46 to 86 years. The mean follow-up period was 40 months. The 1-, 3- and 5-year cause-specific survival rates (Kaplan-Meier's method) for all of the patients were 90.8, 82.9%, and 68.6%, respectively. The prognostic significance of the 5 pathological factors (grade, pT, pV, pL and pN) were evaluated. All these factors affected the survival rates significantly in univariate analysis using the generalized Wilcoxon test. According to multivariate analysis by the Cox proportional hazard model, the most influential prognostic factor was grade.     

A clinical study of renal pelvic and ureteral cancer: prognosis and frequency of subsequent bladder cancer following surgical treatment

PURPOSE: A retrospective investigation of patients presenting with renal pelvic and ureteral cancer was performed. This study focused on the prognostic factors and frequency of subsequent bladder cancer following surgical treatment. MATERIALS AND METHODS: Forty-five patients presenting with transitional cell carcinoma, who had undergone nephroureterectomy at the Department of Urology, Okayama Central Hospital, from March 1990 to November 2000, were reviewed. Various factors were evaluated according to survival and non-bladder cancer occurrence rates. The Kaplan-Meier method was used in the analyses. RESULTS: Patients consisted of 33 males and 12 females (mean age was 71.7). Seventeen patients exhibited renal pelvic cancer, 25 cases displayed ureteral cancer and three subjects presented with multiple cancers. Eleven patients had received treatment for precedent or coexistent superficial bladder cancer by transurethral resection. The overall 5-year survival rate was 71.9%. Ten patients died as a result of the disease; in all cases, lymph node or distant metastasis had progressed. Pathological T factor, tumor grade and pN factor demonstrated a significant effect on survival; however, sex, age, tumor localization and incidence of subsequent bladder cancer had no influence on survival. The 5-year non-bladder cancer occurrence rate was 38.8%; additionally, all subsequent bladder cancer was disclosed within three years. Tumor multiplicity exclusively in the upper urinary tract significantly affected occurrence of bladder cancer. T factor and tumor grade revealed no correlation to occurrence. CONCLUSIONS: Adjuvant chemotherapy for prevention of clinical metastasis should be considered in cases involving pT3 or higher stage, grade 3, or in instances of pathologically confirmed lymph node metastasis. The significant occurrence of subsequent bladder cancer in the case of tumor multiplicity suggested that prophylactic therapy such as intravesical BCG instillation or chemotherapy might be beneficial.     

A clinical study on renal pelvic and ureteral tumors

Thirty-seven cases of renal pelvic and ureteral tumors treated at our hospitals between January, 1975 and December, 1985 were reviewed. There were 15 renal pelvic tumors, 19 primary ureteral tumors and 3 ureteropelvic tumors. There were 26 males and 11 females and their average age was 62.5 years old ranging from 37 to 82. The most frequent chief complaint was macroscopic hematuria, which was seen in 89% of the patients (33/37). It was 35% of the patients (13/37) who visited our hospitals more than one month but less than three months after the appearance of symptoms. The positive rate of urine cytology was 69%. Total nephroureterectomy was performed on 22 patients and the other surgical treatments were done on 13 patients. Histological examination revealed transitional cell carcinoma in all cases. The overall actual postoperative survival rate at 1, 3 and 5 years was 83.9%, 68.0% and 68.0%, respectively, as measured by the Kaplan-Meier's method. None of the patients who survived more than 3 years after surgery died. The actual 3 and 5 year survival rates in cases of ureteropelvic tumors were slightly lower than those in the case of bladder tumors. There was no evidence in this series to show the usefulness of postoperative adjuvant chemotherapy.     

A clinical study on renal pelvic and ureteral tumor associated with bladder tumor with special reference to risk factors of subsequently recurrent bladder tumor]

PURPOSE: The purpose of this report is to analyze the clinical feature of renal pelvic and/or ureteral tumor (RUT) associated with bladder tumor (BT) with special reference to risk factors of subsequently recurrent BT. METHODS: Of the 49 patients with RUT who underwent surgery and were diagnosed pathologically as transitional cell carcinoma at the Department of Urology, Osaka National Hospital from April 1986 to October 1996, 20 patients (40.8%) had associated BTs. These patients were categorized to the following 4 groups, Group 1: 5 patients with BT preceding RUT, Group 2: 5 patients with concomitant BT, Group 3: 10 patients with subsequent BT following RUT operation and Group 4: 29 patients without any associated BT. The clinical course of these 4 groups were studied and compared with each other retrospectively. RESULTS: In group 1, the first BTs preceded RUTs by 19 to 81 months (mean 54.6 months). And during this relatively long period, the preceding BTs were treated by TUR for each recurrence, 1 to 9 times (mean 5.2 times). Two of 5 were bilateral RUT cases, which were observed only in this group. In group 2, the prognosis were relatively poor (5-year survival rate: 0%), because all RUTs of this group were high stage. And also the concomitant BTs were showing invasive feature during the observation period, despite they were superficial at first. Thus 3 of 5 underwent radical cystectomy. On the other hand, in group 3, the subsequent BTs, which developed at 2 to 26 month (mean 13.4 month) after RUT operation, were all superficial and resectable by TUR. The 5-year disease specific survival rate was 50% in group 1, 0% in group 2, 63.5% in group 3, 64.9% in group 4. Group 2 had the most poor prognosis. However there was no significant difference in prognosis among the 4 groups. Incidence of preoperative urine positive cytology was significantly higher in group 3, than in group 4 (87.5% vs. 44.8%). CONCLUSIONS: These results indicated that the RUTs with associated BTs have distinct clinical features depending on the sequence of association with the BTs. Especially the RUTs with concomitant BTs should be watched carefully as a high risk group with poor prognosis and possible development of invasive BTs. Positive urine cytology prior to RUT operation may reflect biological activity of tumor cell for dissemination in the lower urinary tract and we suggested preoperative urine cytology was possible predictor of subsequently recurrent BTs after RUT operation in this study.     

A clinical study of patients undergoing curative surgery for renal pelvic and ureteral cancers

We retrospectively studied 30 patients who underwent curative surgery for renal pelvic and/or ureteral cancer between August 1987 and August 1998. Their clinicopathological features were classified by the criteria of the Japanese Urological Association. The 1-, 3-, and 5-year cause-specific survival rates were, respectively, 100, 95.5, and 85.1%, while the disease-free rates were 100, 78.9, and 78.9% by the Kaplan-Meier method. Prognostic factors were evaluated by the log-rank test. The significant prognostic factors were pT3 and pV1 for cause-specific survival (p = 0.0277, p = 0.0025), while pT2 (or higher), grade 3, and pV1 were significant for disease-free survival (p = 0.0271, p = 0.0327, and p = 0.0002). Nine patients who received adjuvant chemotherapy are alive, but 3 patients have relapsed. Chemotherapy did not have a significant effect on the cause-specific survival or disease-free survival.     

A clinical study of 33 cases of renal pelvic and ureteral tumors

Thirty-three cases of primary renal pelvic and/or ureteral tumors, i.e., 14 renal pelvic tumors, 14 ureteral tumors and 5 renal pelvic and ureteral tumors, treated at our hospital between November, 1976 and August, 1987 are reviewed retrospectively. Tumor occurred on the right side in 18 cases, left side in 14 cases and bilateral in one case. The patients ranged in age from 33 to 77 years (average 65.7 years), the sex ratio was 4.5:1 with male predominance over female. The most frequent symptoms were gross hematuria in 22 cases (67%). Interval from onset of initial symptoms to first visit within one month for 23 cases (70%). The major findings of excretory urograms were non-visualizing kidney in 18 cases (55%) and filling defect in 12 cases (36%). Positive urinary cytology was obtained in 18 cases (55%). Operative therapy was performed in all cases, namely, total nephroureterectomy with partial cystectomy in 21 cases (64%) and nephrectomy with transurethral ureterectomy in 7 cases (21%). Histopathologically, all cases but one case of squamous cell carcinoma were transitional cell carcinoma. Subsequent bladder tumors were found in 10 cases (30%). The overall survival rate at 1, 3 and 5 years were 84%, 68% and 61%, respectively by Kaplan-Meier method. In this series, grade and stage of tumor were the most influential factors for prognosis.     

A case of CEA-producing renal pelvic and ureteral cancer

We report a case of carcinoembryonic antigen (CEA)-producing renal pelvic and ureteral cancer. A 62-year-old man consulted a local hospital with the chief complaint of right flank pain. On ultrasonography and CT scan, right hydronephrosis with the renal pelvis and ureteral tumor were detected, and he was referred to our hospital. Both serum levels of CEA and CA19-9 were elevated to 36.9 ng/ml and 119 u/ml, respectively. Close examination of the gastro-intestinal tract did not detect any sign of digestive tumor. Right nephro-ureterectomy was performed, and the tumor was histologically diagnosed as TCC G2 > G3 pT3, and CEA was positive in the tumor cells immunohistochemically. CA19-9 was also positive both in the tumor cells and normal epithelium of the renal tubules. Postoperatively, multiple lung metastases developed despite chemotherapy and the patient died 4 months after surgery. CA19-9 had immediately decreased to the normal range after preoperative percutaneous nephrostomy. CEA had transiently decreased postoperatively, but then increased with lung metastases, apparently related to the state of cancer.     

A clinical investigation on renal pelvic and ureteral tumors

The 60 cases of primary renal pelvic and ureteral tumors treated at Mie University hospitals between January 1977 and December 1987 were reviewed and factors predicting the prognosis were investigated. The patients consisted of 47 men and 13 women (3.6: 1.0). Their ages ranged from 38 to 82 years with a mean of 65.2 years. According to Akaza's category classification of the ureteropelvic tumor, 42 cases were classified to category A, 15 cases category B and 1 case was classified to category C. Histologically, 59 transitional cell carcinomas and 1 squamous cell carcinoma were found. As to grading, 5 was G1, 31 G2, 21 G3 and 2 GX. As to staging, 20 were pT1, 10 pT2, 21 pT3, 3 pT4 and 6 pTX. Staging was correlated well with grading. Total nephroureterectomy with bladder cuff was performed on 39 patients and the other surgical treatments were done on 15 patients. Recurrence of the bladder tumor was found in 22.4%. The 5-year survival rate (Kaplan-Meier's method) was 47.8% for all of the patients. Among the patients with transitional cell carcinoma, the 5-year survival rate was 100% for G1, 57.6% for G2 and 28.6% for G3. As to staging the 5-year survival rate was 90.0% for below pT1, 20.0% for pT2 and 41.1% for pT3. The results from the present study suggest the prognosis is decided by grade and stage in pelvic and ureteral tumors, and it is wanted to develop a system of postoperative adjuvant therapy.     

A clinical study of the renal pelvis and ureteral cancer

During the 13 years from 1976 to 1988, 160 patients with renal pelvic and ureteral cancer were reviewed based on a new general rule for clinical and pathological studies on renal pelvic and ureteral cancer of Japanese Urological Association. There were 71 renal pelvic cancers, 80 ureteral cancers, and 9 cancers in both regions. Patients ranged in age from 35 to 91 years old (average: 63). The involved side was right in 63 and left in 97. The most frequent symptom was hematuria, which was seen in 81.1%. IVP revealed the findings of filling defects, hydronephrosis, and non-visualized kidney in 99.7% of the patients. Total nephroureterectomy with bladder cuff resection was performed in 123 cases, nephroureterectomy in 16 cases, nephrectomy in 5 cases, partial ureterectomy in 10 case, and biopsy in 6 cases. As adjuvant therapies, irradiation was performed in 32 and chemotherapy in 123. Histologically, 156 were with transitional cell carcinoma, one squamous cell carcinoma, one adenocarcinoma and 2 unclear, the over-all survival rate of this study at 1, 3, 5 and 10 years were 86.8%, 73.0%, 65.3% and 45.6%, respectively. No patient with lymph-node metastasis (N+) survived longer than 5 years. All patients with M(1) died within one year. There were no difference of prognosis between renal pelvic cancer and ureteral cancer. Regarding various prognostic factors, our series gave the same results as previous reports. However, it should be stressed that pathological grading was the most important prognostic factor.     

A clinical investigation on renal pelvic and ureteral tumors]

Sixty-six patients with renal pelvic and ureteral tumors were treated in our hospital between June 1974 and June 1991. These cases consisted of 27 renal pelvic tumors, 31 ureteral tumors and 8 renal pelvic and ureteral tumors. Their ages ranged from 43 to 86 years old (average: 65). There were 46 males and 20 females. The surgical method involved total nephroureterectomy with a cuff for 44 patients, nephroureterectomy for 3, nephrectomy for 9, total nephroureterectomy with total cystectomy for 5 and partial ureterectomy for 2. Histologically, there were 60 transitional cell carcinomas (TCC), 2 squamous cell carcinomas (SCC) and 4 TCC with SCC. As for the pathological stage, 13 were pTa, 16 pT1, 12 pT2, 11 pT3, 13 pT4 and 1 pTX. Subsequent bladder tumors were found in 13 patients (19.7%). The overall survival rate at 1, 3 and 5 years were 80%, 68% and 52%, respectively according to the Kaplan-Meier's method. In this series, the pathological staging was the most important prognostic factor.     

肾盂输尿管癌术后再发尿路上皮癌

１９７８年１月～１９９２年１２月收治肾盂输尿管癌８５例，术后再发尿路上皮癌２６例。肾输尿管膀胱袖状切除术后再发率（３０．１％）低于肾输尿管全切除术（５４．５％）和肾切除术（７５％）。病侧管口处膀胱癌再发率高。同时发生多部位癌、低级低期者术后再发率高，再发时间多在术后３年以内。术后再发与非再发者５年生存率无显著性差异（Ｐ＞０．０１）。对其再发因素早期发现与预后进行讨论。     

Impact of diagnostic and treatment delay on survival in patients with renal pelvic and ureteral cancer

OBJECTIVE: To investigate the relationships between diagnostic and treatment delay and tumour stage and survival among patients with malignant tumours in the renal pelvis and ureter. MATERIAL AND METHODS: A clinical and histopathological review was performed on 943 patients with a primary malignant tumour in the renal pelvis and ureter. We selected 394 patients who had macrohaematuria as an initial symptom, had no previous history of bladder cancer, had undergone surgery and had adequate follow-up. We performed uni- and multivariate analyses of prognostic factors for disease-specific survival. RESULTS: The median number of days between the first occurrence of macrohaematuria and surgery was 83.5 days (range 4-1770 days). Patients with advanced tumours had the shortest median delay. Advanced tumour stage, a solid growth pattern and vascular invasion were of prognostic importance for disease-specific survival in the multivariate analysis, but diagnostic and treatment delay were not. CONCLUSIONS: Although the delay was unacceptably long it still had no impact on survival, probably because macroscopic haematuria is a late symptom, in particular in high-grade tumours. New screening methods for the early detection of cancer and new treatment modalities are needed to improve the poor prognosis in stage pT3-pT4 tumours.     

Pathological prognostic factors of renal pelvic and ureteral cancer

OBJECTIVE: To determine the pathologic risk factors after nephroureterectomy in patients with urothelial carcinoma of the renal pelvis and ureter. PATIENTS AND METHODS: We investigated the clinicopathological features of 131 patients (94 males and 37 females) with urothelial carcinoma of the renal pelvis and ureter who underwent nephroureterectomy at our department and related facilities from August, 1994 to August, 1997. The mean age of the patients was 68 years, ranging from 24 to 86 years. RESULTS: The 1-, 3- and 5-year cause-specific survival rates (Kaplan-Meier's method) for all of the patients were 91.8%, 76.7%, and 67.8%, respectively. The significant prognostic factors for survival rates by univariate analysis using the log rank test were tumor stage, infiltration pattern, lymphatic invasion, vessel invasion and lymph node metastasis. On the other hand, multivariate analysis using Cox proportional hazards regression model showed the most influential prognostic factors to be vessel invasion and tumor stage. CONCLUSIONS: From these results, in urothelial carcinoma of the renal pelvis and ureter underwent nephroureterectomy, we suggested that vessel invasion and tumor stage were the independent prognostic factors.     

Blunt renal pelvic and ureteral injury in multiple-injured patients

The presence of multiple severe injuries influences the management and results with blunt renal pelvic and ureteral injury. Our 9 patients had an average of 4.5 associated injuries per patient and associated renal pedicle injuries in 4 patients. The poor general condition of the multiple-injured patient precluded the optimal management of the blunt renal pelvic and ureteral injury in 5 of the 9 patients. Delayed repair was performed in 4 patients with a successful result in 3. The fourth patient had a complicated course resulting in nephrectomy. The delay in presentation and diagnosis of the renal pelvic or ureteral injury did not preclude a successful result with delayed repair.     

减少肾盂癌术后再发膀胱癌的临床研究

目的 探讨减少肾盂癌术后再发膀胱癌的方法.方法 回顾性分析1997年10月至2007年12月收治并获随访的227例肾盂癌患者.男性126例,女性101例,年龄34～78岁.全程肉眼血尿176例,腰部疼痛51例.采用两种方法分离患侧管口周围膀胱壁.A方法:沿患侧输尿管分离至膀胱壁;B方法:沿输精管向下分离患侧管口周围膀胱后壁并切断膀胱侧韧带达精囊部位.采用三种方法进行膀胱灌注化疗.方法 1:术后当天开始每周灌注1次,共10次;方法2:术后当天灌注1次,3周后每周灌注1次,共10次;方法3:术后3周开始每周灌注1次,共10次.术后定期膀胱镜检查,随访1～10年.采用χ2检验和Logistic回归对膀胱癌再发率进行分析.结果 术后膀胱癌再发率27.8%(63/227).采用方法A和方法B的患者患侧管口周围区域膀胱癌再发率分别为18.0%(7/39)和12.5%(3/24),两者相比较差异有统计学意义(P<0.05).膀胱灌注化疗方法1、2、3的膀胱癌再发率分别为17.9%(11/67)、20.8%(10/48)、33.3%(17/51),方法1与方法3相比较差异有统计学意义(P<0.05).结论 充分分离确切切除患侧管口周围膀胱黏膜,术后当日开始每周1次膀胱灌注化疗是减少肾盂癌术后再发膀胱癌的有效方法.     

A clinical study of bladder cancer in adolescent patients]

PURPOSE: We have reviewed clinical characteristics of bladder cancer in adolescent patients. MATERIALS AND METHODS: Between 1978 and 1997, we have experienced eight bladder cancer patients of 7 men and 1 woman under 30 years old. Two patients were less than 20 years old and six patient were more than 20 years old. We have reviewed initial symptoms, diagnostic methods, cystoscopic findings, methods of treatment, pathological findings, and prognosis of these patients. RESULTS: The most common chief complaint was asymptomatic macroscopic hematuria. Cystoscopically, all tumors were papillary and solitary except in one case. All of tumors were superficial transitional cell carcinomas and treated with transurethral resection (TUR). Although the tumors in patients of less than 20 years old were pathologically grade 1 and 2, two cases of grade 3 tumors were found in patients more than 20 years old. The prognosis of these patients were good, for none of them was dead and the recurrence rate after TUR was 12.5% (1/8). CONCLUSIONS: We considered that characteristics of bladder cancer in adolescent patients were low stage, low grade, and good prognosis. But it was found that high grade tumors were contained in patients more than 20 years old.