BREAKDOWN OF SUPRAVESICAL UROTHELIOMA ACCORDING TO PROGNOSIS AND TNM CLASSIFICATION

We report on 149 patients with supravesical urothelioma (transitional cell carcinoma of the upper urinary tract) treated in our hospital during the years 1967-1991. The introduction shows the distribution of sex and age as well as the localization of the tumor. Main topic of this paper is a new definition of the clinical pathology of supravesical urothelioma by means of the TNM classification published 1987. Based on the pathological pioneer work of P. Hermanek our results are as follows: during the first diagnosis pT3 predominates with 30.2 %, followed by pT1 with 25.5 % and pTa, pT1 and pT4 with a relatively low incidence. G2 predominates with 47.7 %; G1 and G3 have almost the same frequency. The G/pT ratio shows a decreasing linearity for G1 from pTa to pT4; for G2 there is equivalence of pT1-pT3; and pTa and pT4 are relatively rare. With respect to G3, pT3 predominates with 51 %, followed by pT4, pT1 and finally pTa with zero frequency. The G/M ratio shows MO only for G1, 10% M positive for G2 and 15 % M positive for G3. The 10-year survival rate for patients with R0 resection and stage pTa is 64% and for pT1-pT4, 33-36%. The 10-year survival rate for patients with G1 tumor is 51%, and that for G3 tumors 30%. Multicentric occurrence and carcinoma in situ have no prognostic significance in our sample. As is well known, papillary growth has a better prognosis than solid infiltration. L and V stages, which are not accepted in the TNM system, could show interesting aspects. To sum up, the TNM system conveys a concentrated morphology of the supravesical urothelioma, allowing precise distinctions and prognostic assessment.