Long-term outcomes of upper tract urothelial carcinoma: A retrospective evaluation of single-center experience in 275 patients.

OBJECTIVE: We aimed to report our 25-year experience on upper tract urothelial carcinoma (UTUC) on a larger number of patients with long-term follow-up at a single tertiary urology institute.

MATERIAL AND METHODS: A retrospective study was conducted on 275 patients from 1990 to 2015. Basic patient demographic data with the laboratory and radiologic investigations were collected. We used 1997 TNM classification and the three-tiered WHO grading system. Data were collected using an SPSS® version 21 spreadsheet.

RESULTS: The mean age was 59±11 years, and 88% of all the patients were male. Previous and concurrent bladder tumors were found in 16% and 26%, respectively. Computed tomography (CT) gave an overall accuracy of 96%. Open nephroureterectomy (NU) and bladder cuff excision was performed for 85%, and the remaining by laparoscopy and nephron-sparing surgeries. Tumor was pelvicalyceal, ureteric, and both in 40%, 40%, and 20% respectively. In 97% of the patients, the tumor was transitional cell carcinoma. Nearly two-thirds of the patients were of low grade and non-invasive in stage. Nearly half of the patients (46%) had bladder tumor recurrence after NU. Bladder, urethral, and contralateral recurrence, distant, local metastasis occurred in 46%, 2%, 1%, 7.5%, and 6%, respectively.

CONCLUSION: UTUC is a unique disease with synchronous and metachronous urothelial tumor recurrence that requires long-term surveillance. The majority (two-thirds) of the patients are non-invasive in stage of grade II. Tumor stage is of paramount prognostic significance for survival; the five-year survival rate of T1 and T4 is 80% and 0%, respectively.