Prognostic factors for upper urinary tract urothelial carcinomas: stage, grade, and smoking status.

OBJECTIVES: Upper urinary tract urothelial carcinomas are relatively rare malignancies. The aim of this study was to investigate the factors affecting prognosis of patients undergoing nephroureterectomy.

METHODS: Data of 140 patients undergoing nephroureterectomy were retrospectively analyzed. Age of patients, gender, focality and localization of tumor, clinical and pathological stage, relationship with bladder cancer (prior, synchronous, after), and history of smoking were retrospectively recorded. The condition of local recurrence, metastases to distant organs, and requirement of adjuvant treatment were evaluated.

RESULTS: The disease-specific and recurrence-free 5-year survival rate was determined as 78.9 and 68.4%, respectively. Bladder recurrence was determined in 20 of the patients after a mean of 21 months (7-37 months). Relationship between the duration of recurrence and variables showed that patients with T2 and higher stages (P = 0.014), with high-grade tumors (P = 0.028), with multifocal tumors (P < 0.001), and patients who were cigarette smokers (P = 0.010) had significantly shorter durations of recurrence. The mean survival of the 19 (18.1%) patients who had distant metastases was 19 months. Pathological stage T2 and higher tumors (P = 0.006), nodal involvement (P = 0.04), high-grade urothelial carcinoma (P < 0.001), multifocal tumors (P < 0.001), and tumors localized in the ureter (P < 0.001) were observed to have shorter duration of metastatic development.

CONCLUSIONS: Presence of T2 and higher-stage tumors, high-grade tumors, and multifocality are combined risk factors for urinary bladder recurrence and distant organ metastasis. Patients with the additional risk factors of cigarette smoking (urinary bladder recurrence) and nodal disease (distant organ metastasis) should be followed up closely after surgery.