1. Upper Tract Urothelial Cancers at Tzu-Chi, Hualien By Wei-Min Tsai

2. 演講主軸 : 病歷寫作  Review of charts –Specify dates of diagnosis and definitive treatment, especially cancers –Specify clinical and pathological stages, TNM system –Specify dates and sites of progression –Accuracy

3. Wei-Min Tsai Computerized Charts 疾病分類住院報表 查詢條件 : Ureter cancer 查詢年度 : 開院 -95.1.31 個案總數 : 46 編號病歷號姓名性別追蹤狀況 最後追蹤 日死亡日期 最初診斷 日 1B100550007 蔡丁掌男存 930305 900307 2H100057454 李添財男死 891230 890418 3Q200152792 李何麗鸚女死 830928 830108 4S102834493 戴順生男存 930106 890502 5U100021712 林忠用男存 941123 851014 6U100052217 張漢統男存 880620 831221 7U100145655 鄭萬發男存 880802 820311 8U101040677 廖仁竹男存 870910 801008

4. Wei-Min Tsai Dreams of Clinical Researcher  Searchable pathology reports including histology, dates and stages –Cancer registry at least for Tzu-Chi hospital  Searchable computerized charts of any random terms like that in Medline  Searchable laboratory results –Specific tests –Specified ranges

5. Wei-Min Tsai Upper Tract TCC at Tzu-Chi, Hualien  From 1989/5 to 2006/8  125 cases diagnosed as renal or ureteral transitional cell carcinoma (TCC)  Charts not found for 14 cases  Clinical features, pathological reports reviewed and compared to those in textbook (Smith’s General Urology)

6. Wei-Min Tsai Upper Tract TCC at Tzu-Chi, Hualien  Epidemiology –Average annual incidence for bladder cancer: 6.3/100,000 (377 cases in 17 years, population in Hualien 347,298) –Average annual incidence for bladder cancer in Taiwan 6.4/100,000 (from 1993 to 2001) –Average annual incidence for upper tract TCC in Hualien: 2.1/100,000 (7 cases yearly at Tzu-Chi, Hualien, 21% from Taitung)

7. Wei-Min Tsai Upper Tract TCC at Tzu-Chi, Hualien  Age at diagnosis: 68.4 years (range from 33 to 93) –Mean age at diagnosis 65 years  Male to female ratio: 0.95:1 (54:57) –Male:female ratio 2-4:1 (Babaian and Johnson, 1980; Hawtry, 1976) –Male:female ratio 1:1.3 ( 高醫 Chou and Huang, 1999) –Male to female: 2.47:1 (2000, Taiwan, 膀胱癌 )  Bladder : renal pelvic : ureteral carcinomas: 6.1:1.1:1 (377:66:62) –51:3:1 (Williams and Mitchell, 1973) –8:0.9:1.1 ( 高醫 Chou and Huang, 1999)

8. Wei-Min Tsai Upper Tract TCC at Tzu-Chi, Hualien  Developing bladder TCC concomitantly or afterwards: 34.2% (38/111) –30-50% at risk  Developing contralateral upper tract TCC: 5.4% (6/111) –2-4% at risk  Primary bladder TCC developing upper tract TCC: 1.4% (5/356) –<2% (Oldbring et al., 1989)

9. Wei-Min Tsai Upper Tract TCC at Tzu-Chi, Hualien  Right: left: bilateral 52:53:2  Symptoms: –Gross hematuria 66.7% (74/111) –Flank pain 17.1% (18/111) –Hydronephrosis 7.2% ( 8/111)  Treatment: –Nephroureterectomy72.1% (80/111) –Nephrectomy 8.1% ( 9/111) –Segmental resection 5.4% ( 6/111)

10. Wei-Min Tsai Upper Tract TCC at Tzu-Chi, Hualien  13 cases (11.7%) had dialysis history 0.5 months to 14 years before diagnosis.  2 cases had renal transplantation 2 to 13 years before diagnosis  3 cases had 2 nd cancers including hepatocellular carcinoma, cholangiocarcinoma and laryngeal cancer

11. Wei-Min Tsai

12. TaT1T2T3N1M1 Low stage (67.5%, 54/80) 10 31 13 High stage (32.5%, 26/80) 11 11 11 13 33 111 11 5 Total1032151749 Staging of Upper Tract TCC at Tzu-Chi, Hualien

13. Wei-Min Tsai

14. Characteristics of Upper Tract TCC at Tzu-Chi, Hualien Current 高醫 Textbook Mean age68.461.865 Male/Female0.95/10.77/12-4/1 Bladder/renal pelvis/ureter6.1/1.1/18.9/1.2/151/3/1 Bilateral involvement5.4%4.4%2-4%

15. Wei-Min Tsai 感謝 Dr. 陳嘉彥 Ms 李惠晴 病歷室 病理科