Primary urothelial carcinoma of the upper urinary tract in dialysis patients with 5-year follow-up.

OBJECTIVE

In this study, we assessed the clinical and pathological characteristics of urothelial cancers of the upper urinary tract (UUT) in patient under dialysis and evaluated the efficacy and complications of surgical management of the disease.

METHODS

A total of 70 dialysis patients with primary urothelial carcinoma (UC) of the UUT were identified with 5-year follow-up after surgery (61-122 months). Potential factors were analysed to determine the risk factors of subsequent tumours and unfavourable prognostic factors of overall survival. Incidence of urothelial tumours and overall survival of 7503 dialysis patients were also evaluated.

RESULTS

The incidence of primary UC of the UUT in dialysis patients in Taiwan was 0.93%. The 2-year and 5-year overall survival rates of dialysis patients with primary UC of the UUT were 74.3% and 42.9%, respectively. Subsequent bladder tumours and contralateral UUT tumours developed in 52.6% and 37.9% patients, respectively. No significant risk factor could be identified to predict subsequent tumours in dialysis patients. Pathological stage (P = 0.021) and grade (P < 0.001) were the unfavourable prognostic factors in the log-rank test. No significant difference was observed in perioperative mortality and overall survival between patients receiving one-stage nephroureterectomy and those receiving two-stage bilateral nephroureterectomy; however, the cystectomy procedure increased perioperative mortality according to the chi(2) test (P = 0.042).

CONCLUSIONS

Closely monitoring the residual urinary tracts after nephroureterectomy in dialysis patients with primary UC of the UUT should be performed. There is no statistical difference for overall survival between one-stage and two-stage bilateral nephroureterectomy.