Clinical characters of the primary transitional cell carcinoma of ureter with lower stage and grade / 中华泌尿外科杂志

ABSTRACT

Objective To discuss the diagnosis,therapy and prognosis of primary ureter transitional cell carcinoma with low stage and grade.Methods Retrospective review of 18 cases surgery to treat the primary ureter carcinoma of G1-2 Ta-2 was carried out.There were 12 males and 6 females with the mean age of 67 years.Of the 18 cases with the size of tumor were from 0.5 to 1.5 cm.13 cases had the tumors on the left and 5 cases on the right.The tumors were located at middle parts of the ureter in 3 cases,and at the lower part in 15 cases.The course of the disease was from 5 days to 3 months.10 cases had gross hematuria and 8 cases renal hydronephrosis were found incidentally by B-ultrasound.B-ultrasound was performed in all cases.15 cases were indicated pyelic separation from 1.0-1.5 cm and ureteral separation from 0.8-1.0 cm.8 cases were indicated the low-echo space-occupying disease of ureter.IVU indicated mild hydronephrosis in 12 cases of 15 cases,of whom 5 cases were demonstrated a filling defect.CT indicated the mass of ureter in 10 cases of 15 cases.Cystoscope were performed in 18 cases,of whom 5 cases were found the tumor in the ureter-bladder cuff.Retrograde pyelogram showed filling defect of the diseased ureter in 10 of 11 cases(2 cases had failure of intubation).4 cases ureteroscopy with biopsy were used and demonstrated the diagnosis.Results 8 cases were treated surgically of radical nephroureterectomy with a bladder cuff excision.7 cases were performed ureteral segmental resection,of which 2 cases anastomosis and 5 cases ureterocystostomy with bladder cuff excision.3 cases tumors were resected by ureteroscopy postoperative pathological findings confirmed the diagnosis of transitional cell carcinoma.Pathological staging showed Ta(1 case);T1 (8),T2(9),and grading showed G1(8);G2(10).16 cases(88.9％)were followed up form 6-132 months.The overall 5-year survival rate was 87.5％.Of the 25％ patient showed bladder recurrence in post-operation 6-24 months.2 cases died of tumor recurrence and metastasis in post-operation 36-48 months.Conclusions The primary transitional cell carcinoma of ureter was uncommon and has poor prognosis.Ureter carcinoma with lower stage and grade might have better prognosis.Kidney-sparing surgery is a feasible treatment option in patients with lower stage and grade.The long-term follow up is meticulous.