目的：回顧高雄榮民總醫院侵犯性上泌尿道移形上皮細胞癌的治療結果。材料與方法： 自 1991 年 3 月至 1996 年 12 月共有 46 位侵犯性上泌尿道移形上皮細胞癌的病患接受根除性手術，其中男性有 31 位，女性有 15 位，年齡分佈為 43 至 82 歲（中位數67 ）。 其中有 16 位接受手術後放射線治療， 總劑量範圍是 48.6 至 60Gy （中位數 55）；14 位接受手術後化學治療，使用 MVEC （ methotrexate, vinblastine, epirubicin,cisplatin ）或 MCV （ methotrexate, cisplatin, vinblastine ） 2 至 12 個療程（中位數 4 ）。T2、T3、T4 （ AJC，1992 ）各有 20、21、5 例，手術時已有淋巴結轉移者有4 例，輸尿管腫瘤者有 24 例。結果：經過 5-65 個月的追蹤（中位數 32 ），發生局部復發者有 7 例（ 15 ％），發生遠端轉移者有 16 例（ 35 ％）。所有病患的 5 年存活率是19 ％，5 年無病存活率是 16 ％。 預後因子中，手術時沒有淋巴結轉移及原發部位為輸尿管腫瘤對 5 年存活率與 5 年無病存活率而言是預後較佳因子且達到統計上的差異。單獨手術者、 手術後放射線治療者及手術後化學治療者之 5 年存活率分別是 16 ％、12 ％及 37％（ p=0.43 ），而 5 年無病存活率分別是 15 ％、10 ％、27 ％（ p=0.37 ）。 手術後放射線治療者無嚴重併發症發生。手術時已有淋巴結轉移者有 4 例，其中 3 例發生遠端轉移而且已死亡。 發生第二個泌尿道腫瘤者有 8 例，發生部位均在膀胱。結論：不論是否給予手術後放射線治療或化學治療，均有相當高比例的病人發生遠端轉移。手術時沒有淋巴結轉移及原發部位為輸尿管腫瘤對 5 年存活率與 5 年無病存活率而言是預後較佳因子。手術後化學治療者的 5 年存活率與 5 年無病存活率較單獨手術者與手術後放射線治療者為佳，雖未達到統計上的意義，但值得進一步研究。

　　　　　Purpose：To review the treatment results of invasive transitional cellcarcinoma of upper urinary tract at Veterans General Hospital-Kaohsiung.Materials and Methods： From March 1991 to December 1996, 46 patients withinvasive transitional cell carcinoma of the upper urinary tract received radicalsurgery. There were 31 male and 15 female patients. Patients's age rangesbetween 43 and 82 years. （ median： 67 ）.Sixteen patients receivedpost-operative radiotherapy with dosages of 48.6 to Gy （ median： 55 ） to thetumor bed. Fourteen patients received 2 to 12 courses （ median： 4 ） ofpost-operative chemotheray using regiments of MVEC （ methotrexate, vinblastine,epirubicin, cisplatin ） or MCV （ methotrexate, cisplatin, vinblastine ）.Twenty, 21,5 patients were pathologically staged as T2,T3,T4 （ AJCC,1992 ）,respectively. Four patients had lymph node metastasis pathologically. Twentyfour patients had tumor confined to ureter only. Results：Follow-up durationranges from 5 to 65 months （ median： 32 ）. Overall,7 patients （ 15 ％）developed local recurrence and 16 patients （ 35 ％） developed distantmetastasis. Overall 5-year survival rate （ 5 YSR ） was 19 ％, and 5-yeardisease-free survival rate （ 5 DFS ） was 16 ％. Negative lymph nodesmetastasis and the ureteral tumor only were statistically significant goodfactors for 5 YSR and 5 DFS. 5 YSR for surgery alone group, post-operativeradiotherapy group and post-operative chemotherapy group were 16 ％, 12 ％ and37 ％ respectively （ p=0.43 ）. 5 DFS for the aforementioned treatment armswere 15 ％, 10 ％ and 27 ％ respectively （ p=0.37 ）. No severe complicationswere observed in patients with post-operative radiotherapy. Three out of the 4patients with lymph node metastasis developed distant metastasis and died. Eightpatients had second location tumors, all of which occurred in the bladder.Conclusions： This study showed relative high incidences of patients developingdistant metastasis regardless of treatment arms was given. Negative lymph nodemetastasis and the ureteral tumor only were good factors for 5 YSR and 5 DFS.The post-operative chemotherapy group had a higher 5 YSR and 5 DFS than theother treatment groups, and the results need further confirmation although itwas not statistically significant.