Urothelial Carcinoma of the Renal Pelvis

Urothelial carcinomas of the renal pelvis are relatively rare tumors, and large series that include clinicopathologic and outcome data are few. We reviewed 130 consecutive nephroureterectomies performed for urothelial carcinoma of the renal pelvis at our institution. Tumors were graded using the World Health Organization/International Society of Urologic Pathologists (WHO/ISUP) grading system and were staged according to the 2002 TNM classification; 83 (63.6%) of the patients were men and 47 (36.4%) were women. The mean age at diagnosis was 67 years (range, 41-93 years). The average tumor size was 3.7 cm; 36 of the cases were multifocal and 5 were bilateral. Lower tract disease occurred in 50.7% (66 cases); 38 of the cases (29.3%) were low grade and the remaining 92 (70.7%) were high grade. A total of 50% of the cases were pTis, pTa, or pT1, while 45% invaded deeply (pT2 or more). Depth of invasion could not be assessed with certainty in 7 cases (5%). Regional lymph nodes were identified/submitted in only 50 cases. Of those, 12 cases (24%) had lymph node metastasis. Follow-up information was available in 125 (96%) patients. The period of follow-up ranged from 1 week to 176 months (mean, 48.9 months). At last follow-up, 47 patients (36%) had died of other causes, 18 (13.8%) were dead of disease, 8 patients (6%) were alive with disease, and 52 patients (40%) were alive with no evidence of disease. In univariate analysis, histologic grade (P = 0.001), TNM stage (P = 0.0001), vascular invasion (P = 0.001), margin status (P = 0.021), and size (P = 0.0003) were significantly associated with survival. On multivariate analysis, TNM stage (P = 0.03) was the only variable associated with survival. In conclusion, our study shows that a high percentage of the urothelial carcinoma of the renal pelvis present with locally advanced (pT2 or more) disease at the time of nephroureterectomy. Pathologic stage is the most potent predictor of survival, similar to lower tract disease. A subset of the cases could not be staged due to processing issues; we thus recommend fixation prior to prosecting.