Clark P E, Streem S B, Geisinger M A
Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA.
J Urol. 1999 Mar;161(3):772-5; discussion 775-6.
We determined the immediate and long-term results of percutaneous management of upper trace transitional cell carcinoma in regard to rates of tumor recurrence and preservation of renal function.
Since July 1985, 12 men and 5 women 50 to 86 years old (mean age 72.2) years old underwent percutaneous management of upper tract transitional cell carcinoma. Of the patients 12 (71%) had a solitary kidney and 1 was treated bilaterally. In 16 of the 18 treated renal units (89%) definitive percutaneous resection of the tumor was followed by 6 weekly percutaneous installations of bacillus Calmette-Guerin.
Complete resection was accomplished in 17 of the 18 renal units. Of the 18 renal units 15 (83.3%) had documented stage pTa lesions and 14 (77.8%) had grade 1/3 or 2/3 disease. Followup for all patients ranged from 1.7 to 75.5 months (mean 20.5). At the latest followup 11 patients (64.7%) are alive with no evidence of disease, and 6 (35.3%) died, 3 of whom (17.6%) had metastatic transitional cell carcinoma. Of the 13 patients undergoing treatment to solitary kidneys or bilaterally followup ranged from 1.7 to 75.5 months (mean 23.6). Serum creatinine ranged from 1.1 to 3.5 mg./dl. (mean 1.6) before percutaneous tumor resection and from 1.1 to 2.2 mg./dl. (mean 1.6) at the latest followup. Only 1 of these 13 patients (7.7%) with a solitary kidney has required dialysis. Ipsilateral local recurrence developed in 6 of the 18 renal units (33%), and in 4 of these 6 patients (67%) the tumor was grade 2/3 or 3/3 at initial resection. These recurrences were treated endoscopically in 4 patients, 3 of whom are currently without evidence of disease, and with nephroureterectomy in 2. Of the 17 patients only 1 (5.9%) with high grade (3/3), invasive (pT2) primary tumor at initial resection died of locally persistent or recurrent disease.
Percutaneous management of upper tract transitional cell carcinoma is technically feasible and applicable in a significant number of patients in whom nephron sparing management is otherwise warranted. In carefully selected patients the results are at least comparable to other forms of "conservative" management in terms of tumor control and preservation of renal function.
