Grade of Hydronephrosis and Tumor Diameter as Preoperative Prognostic Factors in Ureteral Transitional Cell Carcinoma

Objectives: To evaluate the clinical significance of the grade of hydronephrosis and the tumor diameter in ureteral transitional cell carcinoma. Methods: From 1986 to 2004, the medical records of 104 patients who were treated with nephroureterectomy and diagnosed with ureteral transitional cell carcinoma were retrospectively reviewed. The correlation of the grade of hydronephrosis and tumor diameter with the pathologic T stage was investigated. Also evaluated were the effects of the grade of hydronephrosis and tumor diameter on the prognosis. Results: The grade of hydronephrosis was grade 0 in 11 patients, grade 1 to 2 in 36, and grade 3 to 4 in 57. The tumor diameter measured on the transverse section of the computed tomography scan was less than 1.5 cm in 40 patients, 1.5 cm or greater but less than 2.5 cm in 37, and 2.5 cm or greater in 27 patients. Of the 57 patients with grade 3 to 4 hydronephrosis, invasive tumor was found in 49 (86.0%). Of the 64 patients with a tumor diameter of 1.5 cm or greater, invasive tumor was found in 51 (79.7%). The grade of hydronephrosis and the tumor diameter correlated with the T stage (P <0.001). In addition, the grade of hydronephrosis (P = 0.022) and the tumor diameter (P = 0.008) had a significant influence on disease-specific survival. Conclusions: The results of our study have demonstrated that the grade of hydronephrosis and the tumor diameter correlate with the pathologic T stage and have a significant influence on prognosis. Thus, radical surgery is required for patients with severe hydronephrosis or a large tumor diameter, rather than conservative surgery.