Comparisons of prognosis between urothelial carcinoma of the upper urinary tract and bladder with pT3-4 cancer.

The oncological outcomes of upper tract urothelial carcinoma (UTUC) and bladder cancer (BC) in patients treated with radical surgeries remains controversial. A retrospective analysis of the clinicopathologicla data of 228 consecutive UTUC patients and 174 BC patients treated with radical surgeries from 2000 to 2012 at a high-volume center in China was conducted. Kaplan-Meier method and Cox regression were used to compare overall survival (OS) and cancer-specific survival (CSS) and to find prognostic factors. In this cohort of patients, BC were associated with male sex (P<0.001), multifocality (P<0.001), positive lymph node (P=0.002), no hydronephrosis (P<0.001) and open surgical approach (P<0.001). UTUC have statistically significant better 5-year CSS rate (61.0% vs. 49.8%, P=0.008) and OS rate (58.3% vs. 37.4%, P<0.001) than BC. Bladder tumor location (UTCU vs. BC: hazard ratio (HR)=0.703 and HR=0.462) and positive lymph node status (HR=1.919 and HR=1.667) were independent risk factors of cancer-specific death and overall mortality, respectively. Our data suggest that locally invasive urothelial carcinomas (UC) behave differently in the upper and lower urinary tracts. UTUC has a better prognosis than BC when stage and grade are considered simultaneously and lymph node involvement has significant influences on clinical outcomes of urothelial carcinoma.