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Clinico-pathological characteristics and outcome of upper urinary tract urothelial carcinoma presenting to a tertiary care urology unit in Sri Lanka

Authors:

U Jayarajah ,

National Hospital of Colombo, LK
About U
Department of Urology
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M H Fernando,

National Hospital of Colombo, LK
About M H
Department of Urology
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K B Herath,

National Hospital of Colombo, LK
About K B
Department of Urology
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S N Kuruppu,

National Hospital of Colombo, LK
About S N
Department of Urology
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U L Wickramanayaka,

National Hospital of Colombo, LK
About U L
Department of Urology
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I U Fernando,

National Hospital of Colombo, LK
About I U
Department of Urology
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V C de Silva,

University of Colombo, LK
About V C
Department of Pathology, Faculty of Medicine
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S A S Goonewardena

National Hospital of Colombo, LK
About S A S
Department of Urology
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Abstract

Introduction

Upper urinary tract urothelial cancers  account for 5% of urothelial tumours. In the West, the majority affect the pelvicalyceal system, with pyelocalyceal to ureteric ratio of 3:1. This study aims to describe the clinico-pathological features and outcome of upper urinary tract urothelial cancer treated surgically in a tertiary care unit in Sri Lanka.

Methods

A retrospective analysis of all patients who underwent nephroureterectomy for upper urinary tract urothelial cancer at the Urology Unit at National Hospital of Sri Lanka between January1997 and December 2016 was carried out.

Results

There were 43 patients. Male: female=1.87. Median age was 65 years (range:42-83).  Macroscopic haematuria was the commonest presentation (n=29; 67.4%). Median duration of symptoms was 3 months (range 0.5-6). In the majority (n=20;46.5%) the tumour was confined to the ureter. Thirty-three (75.6%) were papillary tumours. Twenty-one had non-muscle invasive tumours (pTa: n=6(14%), pT1: n=15(34.9%) and others had invasive cancers (pT2: n=11(25.6%), pT3: n=7(16.3%) and pT4: n=4(9.3%)). Majority were low grade tumours (n=23;53.5%). Twelve (27.9%) had preceding urothelial bladder cancer. Nineteen (44.2%) were lost to follow up after surgery. Median follow up duration of the rest was 40 months (range:4-224months). Of them, 9(20.9%) developed metachronous bladder tumours. Nine had recurrence free survival of ≥5years and 15 had overall survival of ≥5 years. Of them, 4 patients survived  ≥10 years. Older age (p=0.015) and presence of necrosis(p=0.05) were the only clinico-pathological parameters predictive of tumour recurrence.

Conclusion

A relatively higher number females and high number of ureteric tumours were noted compared to similar studies from Asia.

DOI: https://doi.org/10.4038/cmj.v63i3.8717
How to Cite: Jayarajah, U., Fernando, M.H., Herath, K.B., Kuruppu, S.N., Wickramanayaka, U.L., Fernando, I.U., de Silva, V.C. and Goonewardena, S.A.S., 2018. Clinico-pathological characteristics and outcome of upper urinary tract urothelial carcinoma presenting to a tertiary care urology unit in Sri Lanka. Ceylon Medical Journal, 63(3), pp.129–132. DOI: http://doi.org/10.4038/cmj.v63i3.8717
Published on 30 Sep 2018.
Peer Reviewed

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