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Longitudinal Correlation Between Grade Of Upper Tract and Bladder TCC In Patients With Concurrent Disease
Sam N. Chawla, Ilia S Zeltser, Eric D Nelson, Jodi A Antonelli, Marnie R Robinson, Marluce Bibbo, Demetrius H Bagley
Thomas Jefferson University, Philadelphia, PA
Introduction: Our objective was to examine the relationship between upper tract and bladder transitional cell carcinoma (TCC) in patients with concurrent disease.
Methods: A retrospective review of our upper tract TCC database identified 38 patients with concurrent bladder and upper tract disease. All patients underwent endoscopic surveillance consisting of ureteroscopy and cystoscopy with biopsy and treatment. Biopsy specimens from the upper tract were examined with both cytology and cell-block techniques. Bladder tumor specimens underwent routine histopathological analysis.
Results: 38 patients underwent surveillance over a mean interval of 29 months (range: 2-136). A total of 262 evaluations were performed with 174 upper tract recurrences and 117 bladder recurrences. 79 of the 262 evaluations (30%) revealed concurrent upper tract and bladder disease. Upper and lower tract pathology was the same in 42% of cases. In the discordant cases 50% of the upper tract lesions were of higher grade, and 50% of the bladder lesions were of higher grade. Over the course of follow-up 34% of upper tract lesions remained the same, 17% progressed in grade, 20% decreased in grade, and 29% had fluctuating grade. In the bladder 31% of the lesions remained the same, 46% increased in grade, 14% decreased in grade, and 9% fluctuated.
Conclusions: Concurrent upper tract and bladder TCC show grade discordance in over 50% of cases. Over extended follow-up, grade fluctuation was seen both in the bladder and upper tract TCC.
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