Toshio Fujioka

[Relationship between grade and stage of renal pelvic and/or ureteral tumor and associated bladder tumor].

OBJECTIVE The purpose of this study was to analyze bladder tumor (BT) associated with renal pelvic and/or ureteral tumor (RUT), with emphasis on the relationship between the grade and stage of these tumors. METHODS We reviewed 77 cases of RUT operated upon at our hospital during the last 14 years. We herein define stage T1b tumor as invasive since this stage of tumor is considered to have a different biologic behavior and potential compared to stage Ta tumor. RESULTS Of the 77 patients, 29 had associated BTs: 8 with a concomitant BT, 3 with BT antedating RUT, and 18 with a subsequent BT. In addition, one patient with preceding BT and two with concomitant cases developed BT after the RUT operation, permitting 21 cases to be categorized in the subsequent BT group. Thirty one out of 32 cases of associated BTs had the same or a lower grade of RUT while one-patient who initially had G2 T1b RUT developed G3 T2 BT 5 years after total nephroureterectomy. In the preceding cases, two patients with Ta BTs, had Ta RUTs, and one patient with T1b BT antedated T2 RUT. In the concomitant BTs, all four cases with stage Ta RUT exhibited Ta BT, and another four with invasive RUT presented invasive BT. In the subsequent cases, 18 out of 21 patients developed Ta BT. CONCLUSION In the preceding and concomitant cases, associated BT & RUT tend to have the same nature, that is, to be either invasive or non-invasive. In contrast to these cases, 18 out of 21 patients in subsequent cases developed Ta BT. However, since three out of 10 patients with invasive RUT subsequently developed invasive BTs1 careful follow-up for invasive RUT should be mandatory to detect recurrent invasive BTs in their early stage.