During the 10-year-and-9-month period from July 1977 to March 1988, 34 cases of renal pelvic and
ureteral cancer were surgically treated with total
nephroureterectomy combined with
partial cystectomy. In cases where the histopathological examination of the surgically excised specimen disclosed a high stage, high grade
cancer with vascular
tumor invasion, postoperative
adjuvant chemotherapy was carried out using
cisplatin,
cytosine arabinoside and
tegafur. Of the 34 cases, 22 are still alive, 7 (20.6%) died of
cancer and 5 died of other causes. Histopathologically, all of the 7 patients who died of
cancer were found to have grade 3 and stage pT2 or pT3
cancers with intravascular
tumor invasion.
Cisplatin was used in 13 of the 18 high grade, high stage cases with intravascular
tumor invasion. The mortality due to
cancer in these 13 cases was 30.8%, while 3 and 5-year survival rates were 69.2% and 51.9%, respectively. In the remaining 5 cases in which
cisplatin was not used for postoperative
chemotherapy, the mortality due to
cancer was 60.0% and the 3 and 5-year survival rates were 53.3% and 26.7%, respectively. Thus, the patients who received postoperative
chemotherapy tended to show a better survival rate than those who did not, although the difference in the survival curves between the two groups was not statistically significant. The results from the present study suggest the usefulness of postoperative
adjuvant chemotherapy in high stage, high grade renal pelvic and
ureteral cancer with intravascular
tumor invasion.