The effectiveness of adjuvant chemotherapy in transitional cell carcinoma of the bladder (T1/G3 and greater than or equal to T2) and the upper urinary tract were evaluated. Among a group of 136 patients (male 107, female 29) with such tumors, complete tumor resection was possible in 108, in whom duration of survival and disease-free interval with or without chemotherapy were compared. The combination of antineoplastic agents used was changed from 5-fluorouracil (5-FU) + vincristine (VCR) + bleomycin (BLM) or peplomycin (PEP) + mitomycin C (MMC) or 5-FU + VCR + PEP + cyclophosphamide (CPM) + adriamycin (ADM) to CPM + ADM + cis-platinum (DDP) or methotrexate (MTX) + vinblastine (VBL) + ADM + DDP. Of the 59 patients in the chemotherapy group, 23 (39%) had side effects due to the treatment; however, fever and gastrointestinal symptoms were the chief adverse effects and were well tolerated. The 5-year survival rate and mean disease-free interval in the chemotherapy group were 76.3% and 24.6+ months, respectively, in bladder cancer patients, and 78.2% and 25.8+ months in those with upper urinary tract tumors. However, in the non-chemotherapy group (n = 49) the corresponding values were 62.7% and 21.1+ months in patients with bladder cancer and 67.3% and 42.0+ months in those with upper urinary tract tumor. There was a statistically significant difference (P less than 0.05) in the disease-free intervals of the two treatment groups for bladder cancer patients. Recurrence, regardless of time, was observed in 25% of chemotherapy cases and in 65% of non-chemotherapy cases, and this difference was also statistically significant (P less than 0.001). These results suggest that adjuvant chemotherapy for uroepithelial transitional cell carcinoma may be effective in extending survival and significant by protracting the disease-free period, especially in cases of advanced bladder cancer.