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J Urol. 2007 Sep;178(3 Pt 1):792-6; discussion 796-7. Epub 2007 Jul 16.

Imperative indications for conservative management of upper tract transitional cell carcinoma.

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  • 1Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA. krambeck.amy@mayo.edu

Abstract

PURPOSE:

We report our experience with patients with imperative indications for endoscopic treatment for upper tract transitional cell carcinoma.

MATERIALS AND METHODS:

Between 1983 and 2004 we identified 37 patients with a solitary kidney, bilateral disease or preoperative creatinine greater than 2.0 mg/dl who underwent endoscopic treatment for localized upper tract transitional cell carcinoma. A retrospective chart review was performed.

RESULTS:

Of the 37 patients 32 had a solitary kidney, 3 had bilateral disease and 2 had preoperative creatinine greater than 2.0 mg/dl. Median age at diagnosis was 75 years (range 56 to 88). Bladder cytology was positive or atypical in 15 of 31 patients (48%). Tumors were grade 1 to 3 in 2, 13 and 7 patients, respectively, and diagnosed visually in 15. At a median followup of 2.7 years for survivors 23 patients (62%) had a total of 56 upper tract transitional cell carcinoma recurrences. Grade and stage progression occurred in 3 and 3 patients, respectively. Ten of the 23 patients who experienced upper tract recurrence died of transitional cell carcinoma. Overall kidney preservation was achieved in 24 of the 32 patients (75%) with a solitary kidney. At last followup 24 patients had died, including 11 (29.7%) of transitional cell carcinoma, at a median of 2.9 years. Cancer specific survival at 5 years for this cohort was 49.3%.

CONCLUSIONS:

Our results indicate that upper tract tumor recurrence occurs in a majority of patients with imperative indications for endoscopic treatment, underscoring the need for frequent surveillance. While most kidneys can be preserved, cancer specific death is common.

[PubMed - indexed for MEDLINE]
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