Clinical Analysis For 23 Cases Of Primary Transitional Cell Carcinoma Of The Ureter And Review Of The Literature

Objectives: To evaluate prognostic factor for disease-specific survival of patients with transitional cell carcinoma of ureter, and to improve the diagnosis and treatment of primary ureteral carcinoma.Methods: 23 cases of pathologically confirmed primary ureteral carcinoma between 1992 and 2006 were retrospectively analyzed. Univariate and multivariate analyses were performed using Kaplan-Meier method with log-rank test and Cox proportional hazard regression model respectively.Results: Preoperative diagnosis was made with the assistance of cystoscopy, intravenous urograms, retrograde ureteropyelography, ultrasonography, CT and MRI. Surgical intervention of 23 cases included nephroureterectomy with bladder cuff excision in 12, tumor excision and segmental ureterocystectomy in 4, tumor excision and uretero-ureter anastomosis in 4, cystectomy and ureterostomy in 1, and biopsy in 2. All cases were postoperatively confirmed with pathology, and adenocarcinoma coincided in 1 case. 21 cases were followed up for 6 to 124 months with median disease specific survival time 1149.8 days, and 10 of 21 died disease-specifically. 3 year accumulative survival rates according to tumor stages were 100% in Stage I～II and 18.5% in Stage III～IV respectively and 5 year accumulative survival rates in Stage I～II was 66.7%. Postoperative recurrence in 6 cases included bladder recurrence in 5 cases and retroperitoneal lymph node metastasis in 1 case. 5 year accumulative survival rates according to treatment were 85.7% in radical surgery and 44.5% in conservative surgery respectively. Kaplan-Meier analysis identified tumor grades and stages, surgery procedures, and symptom of flank pain as prognostic factors. In Cox regression test pT stages and flank pain were predictive for primary ureter carcinoma.Conclusions: Tumor stages and grades, surgery procedures, and symptom of flank pain were demonstrated to be prognostic factors for primary ureteral carcinoma. Nephroureterectomy with bladder cuff excision was considered as the standard treatment for primary ureter carcinoma, and could decrease the risk of recurrence. Conservative surgery could be selectively performed in early stage carcinoma of distal ureter.