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KMID : 0381219900220010017
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Journal of RIMSK
1990 Volume.22 No. 1 p.17 ~ p.25
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A Clinical Comparative Study of Prognostic Factors on Upper Urothelial Tumor
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Abstract
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Upper urothelial tumors are rare, but -very important tumor because of their malignant behavior and multicentric development not only in place but also in time. Recently there have been much progress in the diagnosis and treatment of upper urothelial tumors. Herein we analyzed retrospectively 21 patients with upper urothelial tumor who had been admitted in Department of Urology, Chung-Ang University Hospital from April, 1973 to June, 1988. All cases were transitional cell carcinoma. Most patients were in 6th and 7th decade and male to female ratio was 2: 1. The most common symptom was gross hematuria (52%). Hematuria, pain and mass were all seen in 3 cases, all of which were in advanced stage. Two most common signs in IVP were filling defect (54%) and nonvisualization of kidney (46%), the latter findings meant advanced stage in 60% (6/10). Retrograde pyelography and lavage cytology were highly helpful in the differential diagnosis of filling defect. CT scan was very accurate in the diagnosis of pelvis tumor, but not so adequate in the staging of upper urothelial tumor. Surgery was performed in all cases, including 14 total nephroureterectomy, 5 simple nephrectomy, 1 radical nephrectomy and 1 partial ureterectomy. Type of operation did not affect survivals. Concomittant urothelial tumors were found in 5 cases (24%) at the initial presentation, and 3 additional tumors were found during follow up, including 2 cases of bladder tumor and 1 case of ureteral stump tumor. Overall 2-and 5-year survival were 65% (11/17) and 43% (6/14). Most important prognostic factors were stage and grade. Nonvisualization of kidney on IVP, positive urine cytology and nodular shape of tumor were poor prognostic factors. Site, number, size and multicentricity of tumor did not affect survivals. Regular cystoscopic follow up is essential, especially in low stage pelvis tumor. It seems that total nephroureterectomy is still the best treatment of upper urothelial tumor, especially in high stage pelvis tumors.
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KEYWORD
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