Between Jan. 1971 and Dec. 1985, 102 consecutive patients underwent total cystectomy and urinary diversion for primary carcinoma of the bladder. Among the patients, planned radiation therapy (2,000 rad. for 5 days) followed by operation was done in 18 patients, therapeutic dose of radiation was given postoperatively in 8 patients and 76 patients underwent operation only The postoperative mortality rate was 3.9%. Early complications occurred in 30% of the 102 patients and included wound infection, urine leak, bowel obstruction and medical complication. An increased late complication incidence was noted among 26 patients receiving pre- or postoperative radiation (50%) compared with those not receiving radiation (32%). Staging errors by CT scanning occurred in 37% of patients, overstaging in 8 (33%) and understaging in 1 (4%). Survival was evaluated in 45 patients and the overall 5-yesr survival rate for patients with transitional cell carcinoma was 38%.
Carcinoma, Transitional Cell ; Cystectomy* ; Humans ; Incidence ; Mortality ; Survival Rate ; Tomography, X-Ray Computed ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urinary Diversion ; Wound Infection

Five hundred forty three patients with transitional cell carcinoma managed at Seoul National University Hospital during a 20 year period between 1965 and 1984 art analyzed retrospectively. We selected 108 patients with stage A tumor for analysis of recurrence by excluding 95 patient with a prior history of bladder cancer, 14 patients whose initial treatment were a total cystectomy, 12 patients whose disease progressed in stage within 3 years following treatment, 58 patients followed up less than 3 years and 65 patients lost to follow up from 352 patients with stage A tumor. The over-all recurrent rate within the first 3 years following resection of stage A tumor was 70%. The influence of the tumor size, number and grade on recurrence was examined. Disease-free status by 36 months according to the tumor size 1cm or smaller, 1-2cm, 3-4cm, 5cm or larger was 57%, 31%, 17% and 7% respectively. All differences were statistically significant. There was no significant difference of recurrence rate between 1 tumor and 2 tumors, but 3 or more tumors showed significantly higher recurrence rate than 2 or less tumors. There was no significant difference of recurrent rate among grade I, Fade II , grade III tumors combined. Total cystectomies without pelvic lymphadenectomy or preoperative irradiation were performed in 110 patients and 77 patients were adequately followed up. Five-year survival rate of stage A, B, C, D was 87%, 26%, 11%, and 0% respectively. Operative mortality among patients undergoing total cystectomy was 4.5%. Metastases were found in the lymph node, adjacent organs and bone in the order of frequency. Only one patient with stage D tumor on initial presentation survived more than 5 years and the average survival length of stage D was 8 months.
Carcinoma, Transitional Cell ; Cystectomy ; Humans ; Lost to Follow-Up ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Seoul ; Survival Rate ; Urinary Bladder Neoplasms* ; Urinary Bladder*

We investigated the value of lymph node dissection in patients with cN0 muscle-invasive transitional cell carcinoma of the upper urinary tract (UUT-TCC). Medical records of 152 patients with cN0 muscle-invasive UUT-TCC, who underwent nephroureterectomy between 1986 and 2005, were reviewed. Sixty-three patients (41.4%) underwent lymph node dissection. The median number of lymph nodes harvested was 6 (range, 1 to 35), and from these, lymph node involvement was confirmed in 9 patients (14.3%). Locoregional recurrence (LR) and disease-recurrence (DR) occurred in 29 patients and 63 patients, respectively. Fifty-five patients (36.2%) had died of cancer at the last follow-up. The number of lymph nodes harvested was associated with the reduction of LR (chi-square(trend)=6.755, P=0.009), but was not associated with DR (chi-square(trend)=1.558, P=0.212). In the survival analysis, N stage (P=0.0251) and lymph node dissection (P=0.0073) had significant influence on LR, but not on DR or disease-specific survival. However, the number of lymph nodes harvested did not affect LR-free, DR-free, or disease-specific survival. We conclude that lymph node dissection may improve the control of locoregional cancer, as well as staging accuracy, in cN0 muscle-invasive UUT-TCC, but that it does not clearly influence survival.
Aged ; Aged, 80 and over ; Carcinoma, Transitional Cell/mortality/*surgery/therapy ; Female ; Humans ; Kidney Neoplasms/mortality/*surgery/therapy ; *Lymph Node Excision ; Male ; Middle Aged ; Neoplasm Staging ; Nephrectomy ; Recurrence ; Retrospective Studies ; Survival Analysis ; Ureteral Neoplasms/mortality/*surgery/therapy

BACKGROUNDPrevious studies showed that the prognostic factors for superficial transitional cell carcinoma of the bladder varied with the findings of different cohorts. Few multivariate analyses of prognostic factors for superficial bladder tumors have been reported in China and bladder preservation as a prognostic index of superficial bladder tumors is limited and scarce in Chinese patients. This study was conducted to analyze a group of risk factors for prognostic outcomes for patients with primary superficial transitional cell carcinoma of the bladder.

METHODSBetween January 1980 to December 2000, 198 patients [172 men and 26 women; mean age (52.98 +/- 11.28) years] with primary superficial transitional cell carcinoma who were pathologically classified as Ta or T1 in Hunan Provincial Tumor Hospital (Changsha, China) were enrolled in this study. Surgical methods included local resection and electric coagulation of bladder tumors, transurethral resection of bladder tumors and partial cystectomy. After initial surgical treatment, patients were followed through a cystoscopy every three months during the first two years and every six months thereafter in the design of retrospective cohort. Survival analysis was performed to analyze risk factors of the prognostic outcomes for transitional cell carcinoma of the bladder. Canonical correlation analysis was conducted to present and interpret synthetically the multi-correlation between all kinds of prognostic outcomes and risk factor in multiply dimensions.

RESULTSThe average follow-up period was (6.65 +/- 4.74) years. Assessments at three, five, and 10 years showed recurrence rates, respectively, of (28.32 +/- 3.45)%, (35.31 +/- 3.83)%, and (42.48 +/- 4.40)%; progression rates of (8.89 +/- 2.14)%, (15.16 +/- 2.94)%, and (23.88 +/- 4.19)%; bladder-preservation rates of (94.68 +/- 1.74)%, (93.87 +/- 1.91)%, and (91.51 +/- 2.49)%; metastasis rates of (8.25 +/- 2.05)%, (11.24 +/- 2.47)%, and (28.94 +/- 4.93)%; and cancer-related survival rates of (95.02 +/- 1.62)%, (90.70 +/- 2.45)%, and (77.14 +/- 4.88)%. The main risk factors for recurrence were histological grade, blood transfusion during surgery and the duration of symptoms. Progression was affected by blood transfusion during surgery, histological grade, the number of re-examinations, and the length of the recurrence-free period. Metastasis was associated with tumor multifocality, hydronephrosis, microscopic growth pattern, and the recurrence-free period. Cancer-related survival was influenced by microscopic growth pattern and the recurrence-free period. Bladder preservation involved only the recurrence-free period. The comprehensive results from canonical correlation analysis showed that the main prognostic outcomes were cancer-related survival, metastasis and progression respectively, while the dominate risk factors were histological grade, tumor multifocality and blood transfusion.

CONCLUSIONSThe risk factors were different for each prognostic outcome of transitional cell carcinoma of the bladder. This is helpful for predicting the prognosis of transitional cell carcinoma of the bladder and designing therapeutic and follow-up strategies for this cancer.

Adult ; Aged ; Carcinoma, Transitional Cell ; mortality ; pathology ; Cohort Studies ; Disease Progression ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; mortality ; Prognosis ; Retrospective Studies ; Risk Factors ; Transfusion Reaction ; Urinary Bladder Neoplasms ; mortality ; pathology

Renal pelvic transitional cell carcinoma (TCC), which invades beyond muscularis into peripelvic fat or the renal parenchyma, is diagnosed as stage pT3 despite its structural complexity. We evaluated the prognostic impact of peripelvic fat invasion in pT3 renal pelvic TCC. Between 1986 and 2004, the medical records on 128 patients who were surgically treated for renal pelvic TCC were retrospectively reviewed. Sixty patients with pT3 disease were eligible for the main analysis. The prognostic impact of various clinicopathological factors was analyzed using univariate and multivariate analyses. On univariate analysis, sex, age, concomitant bladder tumors, concomitant ureter tumors, lymphadenectomy, adjuvant chemotherapy, tumor grade, multiplicity, renal parenchymal invasion, and carcinoma in situ did not influence the disease-specific survival (p>0.05). By contrast, peripelvic fat invasion, lymph node invasion, and lymphovascular invasion were each significantly associated with disease-specific survival (p<0.05). Multivariate analysis showed that peripelvic fat invasion (p=0.012) and lymph node invasion (p=0.004) were independent prognostic factors. In conclusion, peripelvic fat invasion is a strong prognostic factor in pT3 renal pelvic TCC. Thus, systemic adjuvant therapy should be considered in the presence of peripelvic fat invasion, even if the lymph nodes are not involved.
Adipose Tissue/*pathology ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Transitional Cell/mortality/*pathology/surgery ; Female ; Follow-Up Studies ; Humans ; Kidney Neoplasms/mortality/*pathology/surgery ; Lymph Nodes/pathology ; Male ; Middle Aged ; Neoplasm Invasiveness ; Pelvis ; Prognosis ; Retrospective Studies ; Survival Analysis

We examined whether the presence and severity of preoperative hydronephrosis have prognostic significance in patients who underwent radical cystectomy for transitional cell carcinoma of the bladder. The medical records of 457 patients who underwent radical cystectomy for bladder cancer between 1986 and 2005 were retrospectively reviewed. Following the Society for Fetal Urology grading system, patients were divided into low-, and high-grade hydronephrosis groups. Clinicopathologic factors associated with preoperative hydronephrosis and survival were evaluated. Of a total of 406 patients, unilateral hydronephrosis was found in 74 (18.2%), bilateral hydronephrosis in 11 (2.7%), and no hydronephoris in 321 (79.1%). Low-grade hydronephrosis was found in 57 (12.2%) patients and high-grade hydronephrosis in 28 (6%). Preoperative hydronephrosis was related to higher pT stage and lymph node invasion. In univariate analysis, the presence of hydronephrosis, hydronephrosis grade, age, pT and pN stage, tumor grade, surgical margin, number of retrieved nodes, carcinoma in situ, and lymphovascular invasion were significant prognostic factors for cancer-specific survival. In multivariate analysis, bilateral hydronephrosis and high-grade hydronephrosis remained significant predictors for decreased survival. The presence of preoperative hydronephrosis, and high-grade hydronephrosis are significant prognostic factors in patients with bladder cancer after radical cystectomy.
Adult ; Aged ; Carcinoma, Transitional Cell/diagnosis/*mortality/pathology/*surgery ; *Cystectomy ; Female ; Humans ; Hydronephrosis/classification/*pathology ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Urinary Bladder Neoplasms/diagnosis/*mortality/pathology/*surgery

Recently many molecular biologic techniques have been tried to determine a prognostic indicator in various malignancies by evaluating the capacity of cellular differentiation and proliferation and the degree of expression of oncogene products. It is suggested that the activation of EGFR may play a role in normal and abnormal cellular proliferation. Many reports have demonstrated that EGFR is overexpressed in genitourinary, breast, lung, head and neck tumors, and possibly used as tumor marker. In this study we measured EGFR mRNA by in situ hybridization in 64 patients with transitional cell carcinoma of bladder and 14 cases of normal bladder to evaluate its relation to the prognosis. The positive staining of EGFR mRNA by in situ hybridization was observed in 42.8% of normal urothelium and 100% of transitional cell carcinoma of bladder. The strong positive staining of EGFR mRNA was observed in 57.5% of superficial cancer of bladder and 80.6% of invasive one(Ta 25%, T1 62.1%, T2 72.7%, T3 76.9%, T4 100% and Grade I 35%, Grade II 75.9%, Grade III 94.4%, respectively). As tumor stage and grade was increased, the corresponding strong positivity of EGFR mRNA was significant. Progression to invasive cancer occurred in 3 patients with superficial cancer and 2 of them had strong positive EGFR mRNA finding in original specimen. Tumor recurrences occurred in 15 patients with superficial cancer and 8 of them had strong positive EGFR mRNA finding in original specimen. In 20 of the 25 patients(80%) who died of bladder cancer during the study tumors were EGFR mRNA strong positive. The death rate of patients with strong positive EGFR mRNA was significantly greater than that of patient with weak positive EGFR mRNA tumor. In conclusion, The EGFR mRNA expression of transitional cell carcinoma of bladder using in situ hybridization technique may be a useful tumor marker and prognostic indicator.
Breast ; Carcinoma, Transitional Cell* ; Cell Proliferation ; Epidermal Growth Factor* ; Head ; Humans ; In Situ Hybridization* ; Lung ; Mortality ; Neck ; Oncogene Proteins ; Prognosis* ; Receptor, Epidermal Growth Factor* ; Recurrence ; RNA, Messenger ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urothelium

The prognostic impact of body mass index (BMI) in patients with upper tract urothelial carcinoma (UTUC) is an ongoing debate. Our study aimed to investigate the prognostic role of BMI in patients treated with radical nephroureterectomy (RNU) for UTUC from a multi-institutional Korean collaboration. We retrospectively reviewed data from 440 patients who underwent RNU for UTUC at four institutions in Korea. To avoid biasing the survival estimates, patients who had previous or concomitant muscle-invasive bladder tumors were excluded. BMI was categorized into approximate quartiles with the lowest quartile assigned to the reference group. Kaplan-Meier and multivariate Cox regression analyses were performed to assess the influence of BMI on survival. The lower quartile BMI group showed significantly increased overall mortality (OM) and cancer specific mortality (CSM) compared to the 25%-50% quartiles and upper quartile BMI groups. Kaplan-Meier estimates showed similar results. Based on multivariate Cox regression analysis, preoperative BMI as a continuous variable was an independent predictor for OM and CSM. In conclusion, preoperative underweight patients with UTUC in Korea survive less after RNU. Preoperative BMI may provide additional prognostic information to establish risk factors.
Aged ; Asian Continental Ancestry Group ; Body Mass Index ; Carcinoma, Transitional Cell/*mortality ; Cystectomy/*mortality ; Female ; Humans ; Kidney Pelvis/surgery ; Male ; Nephrectomy/*mortality ; Republic of Korea ; Retrospective Studies ; Thinness/*mortality ; Ureter/surgery ; Urinary Bladder/surgery ; Urologic Neoplasms/*mortality/pathology/*surgery ; Urothelium/pathology/*surgery

A clinical observation was made on 30 patients of urologic surgery using the intestinal segment who had been admitted to the Department of Urology, Chungnam National University Hospital from May, 1976 to April, 1982. The results are as follows; 1. The age distribution of the most of cases were fifth and sixth decades (66.7%), and the male to female ratio was 3.3 to 1. 2. Majority of underlying diseases was bladder tumor (76.6%). The other causes were neurogenic bladder (10.0%), Vesicovaginal fistula (10.0%) and contracted bladder (3.3%). 3. Of the 30 cases of urinary diversion, 24 cases were ureteroileocutaneostomy with or without total cystectomy, 3 cases were ureterocolocutaneostomy with total cystectomy, 2 cases were ureteroileocecocutaneostomy with total cystectomy and 1 case was augmented ileocecocystoplasty. 4. Operation mortality was 10%, in which underlying diseases were bladder cancer. 5. Major complications were acute renal failure, septicemia, wound disruption, urine leakage, fecal fistula, ileus, bleeding, pneumonia and evisceration. 6. In the 23 cases of bladder cancer 21 cases were transitional cell carcinoma and 2 cases were adenocarcinoma. Most of the former were composed of stage B & C (66.7%) and grade II & III (71.4%). 7. In cases of malignant disease the overall postoperative survival rate at 1, 3 and 5 years of bladder cancer were 73.9%, 50% and 20% respectively.
Acute Kidney Injury ; Adenocarcinoma ; Age Distribution ; Carcinoma, Transitional Cell ; Chungcheongnam-do ; Cystectomy ; Female ; Fistula ; Hemorrhage ; Humans ; Ileus ; Male ; Mortality ; Pneumonia ; Sepsis ; Survival Rate ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Bladder, Neurogenic ; Urinary Diversion ; Urology ; Vesicovaginal Fistula ; Wounds and Injuries

PURPOSE: To evaluate the impact of adjuvant chemotherapy (AC) in patients with upper tract urothelial carcinoma and lymphovascular invasion (LVI) after radical nephroureterectomy (RNU). MATERIALS AND METHODS: We retrospectively analyzed the clinical records and clinicopatholgic outcomes of patients (n=552) treated with RNU between 1986 and 2013. Patients treated with neoadjuvant chemotherapy and those for whom LVI status was not recorded were excluded. Patients were divided into two groups according to LVI (n=86) or no LVI (n=256). RESULTS: The study included 344 patients (240 men and 104 women) with a median of 53.9 months of follow-up (range, 1-297 months) after RNU. Tumors were organ confined (T2/N0) in 211 (61.3%) and tumor grade high in 291 (84.6%). AC was administered in 64 patients (18.6%). A total of 280 patients (81.4%) were treated with surgery alone. Patients with LVI tended to be older (p=0.049), have a higher pT stage (pT3/T4, p<0.001), be pN+ (p<0.001), have a high tumor grade (p<0.001), and experience recurrence (p<0.001). In the multivariate analysis, LVI was an independent prognostic factor for cancer-specific survival and overall survival (p=0.002 and p<0.001, respectively). The multivariate analysis demonstrated that in the subgroup of patients with LVI, AC was a significant prognostic factor for cancer-specific survival and overall survival (hazard ratio, 0.51; p=0.027 and hazard ratio, 0.50; p=0.025, respectively). CONCLUSIONS: AC does not seem to reduce mortality in patients with advanced upper tract urothelial carcinoma after RNU. In the subgroup of patients with LVI, AC had a positive impact on cancer-specific survival and overall survival. LVI would be helpful for selecting patients who are appropriate for AC.
Aged ; Carcinoma, Transitional Cell/drug therapy/*mortality/surgery ; *Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Humans ; Kidney Neoplasms/drug therapy/*mortality/surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Grading ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Nephrectomy ; Prognosis ; Retrospective Studies ; Survival Rate ; Ureter/pathology ; Ureteral Neoplasms/drug therapy/*mortality/surgery ; Urinary Tract/pathology