Objective: To compare the prognosis of locally advanced upper tract urothelial carcinoma (UTUC) and bladder tumor (BT) in patients treated with radical surgeries.
Methods: We retrospectively reviewed records on 228 consecutive UTUC patients and 174 consecutive BT patients between 2000 and 2012, both with high-stage diseases. Overall and cancer-specific survival was compared using the Kaplan-Meier method. The values of prognostic factors were evaluated by Cox regression analysis.
Results: No difference was observed in age and tumor size between the two groups. The UTUC group had significantly more frequent hydronephrosis than the BT group (48.2% vs. 1.1%, P=0.000). However, the UTUC group showed significantly less frequent high grade (92.1% vs. 98.9%, P=0.002), multifocality (27.2% vs. 53.4%, P=0.000) and lymph nodal involvement (19.3% vs. 32.8%, P=0.002) than the BT group. UTUC had statistically better 5-year cancer-specific survival rate (61.0% vs. 49.8%, P=0.008) and overall survival rate (58.3% vs. 37.4%, P<0.001) than BT. In multivariate analysis, tumor location (HR =0.553), multifocality (HR =0.717), lymph node status (HR =1.920) and hydronephrosis (HR =1.673) were independent risk factors of cancer-specific death. Multivariate analysis revealed that tumor location (HR =0.407), lymph node status (HR =1.651) and hydronephrosis (HR =1.577) were independent risk factors of overall death.
Conclusions: Our data suggest that locally invasive UC behaves differently in the upper and lower urinary tracts. UTUC has a better prognosis than BT when stage and grade are considered simultaneously. Lymph node involvement has severe influences on clinical outcomes of urothelial carcinoma which is consistent with other previous studies.
