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Biological Behavior and Long-Term Outcomes of Carcinoma In Situ in Upper Urinary Tract Managed by Radical Nephroureterectomy

2017; Lippincott Williams & Wilkins; Volume: 199; Issue: 4 Linguagem: Inglês

10.1016/j.juro.2017.10.019

1527-3792

Teruo Inamoto, Hideyasu Matsuyama, Naokazu Ibuki, Kazumasa Komura, Kiyoshi Takahara, Kiyohide Fujimoto, Hiroaki Shiina, Shigeru Sakano, Kazuhiro Nagao, Makito Miyake, Yoshihiro Tatsumi, Hiroaki Yasumoto, Haruhito Azuma,

Urological Disorders and Treatments

No AccessJournal of UrologyAdult Urology1 Apr 2018Biological Behavior and Long-Term Outcomes of Carcinoma In Situ in Upper Urinary Tract Managed by Radical Nephroureterectomy Teruo Inamoto, Hideyasu Matsuyama, Naokazu Ibuki, Kazumasa Komura, Kiyoshi Takahara, Kiyohide Fujimoto, Hiroaki Shiina, Shigeru Sakano, Kazuhiro Nagao, Makito Miyake, Yoshihiro Tatsumi, Hiroaki Yasumoto, Haruhito Azuma, and Nishinihon Uro-Oncology Collaborative Group Teruo InamotoTeruo Inamoto Department of Urology, Osaka Medical College, Takatsuki, Japan More articles by this author , Hideyasu MatsuyamaHideyasu Matsuyama Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan More articles by this author , Naokazu IbukiNaokazu Ibuki Department of Urology, Osaka Medical College, Takatsuki, Japan More articles by this author , Kazumasa KomuraKazumasa Komura Department of Urology, Osaka Medical College, Takatsuki, Japan More articles by this author , Kiyoshi TakaharaKiyoshi Takahara Department of Urology, Osaka Medical College, Takatsuki, Japan More articles by this author , Kiyohide FujimotoKiyohide Fujimoto Department of Urology, Nara Medical University, Kashihara, Japan More articles by this author , Hiroaki ShiinaHiroaki Shiina Department of Urology, Shimane University School of Medicine, Izumo, Japan More articles by this author , Shigeru SakanoShigeru Sakano Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan More articles by this author , Kazuhiro NagaoKazuhiro Nagao Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan More articles by this author , Makito MiyakeMakito Miyake Department of Urology, Nara Medical University, Kashihara, Japan More articles by this author , Yoshihiro TatsumiYoshihiro Tatsumi Department of Urology, Nara Medical University, Kashihara, Japan More articles by this author , Hiroaki YasumotoHiroaki Yasumoto Department of Urology, Shimane University School of Medicine, Izumo, Japan More articles by this author , Haruhito AzumaHaruhito Azuma Department of Urology, Osaka Medical College, Takatsuki, Japan More articles by this author , and Nishinihon Uro-Oncology Collaborative Group More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.10.019AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: In patients with urothelial carcinoma CIS (carcinoma in situ) generally has a poor prognosis. However, to our knowledge the outcomes of pure/primary CIS and the behavior of CIS concomitant with pTa-pT4 upper tract urothelial carcinoma managed by nephroureterectomy have not been previously specified. We explored the biological and prognostic features of concomitant CIS compared with those of pure/primary CIS. Materials and Methods: We queried a multicenter upper tract urothelial carcinoma database. Data from NUOG (Nishinihon Uro-Oncology Group) were analyzed, including patient gender, age, presence of bladder cancer and pT stage. Clinicopathological features were compared between the different subtypes. Cancer specific and overall survival, and the relative excess risk of death were estimated by CIS subtype. Results: We identified 163 patients with CIS in the upper urinary tract, of whom pure/primary CIS was noted in 24.5%. In the concomitant CIS cohort the pathological diagnosis of the nonCIS region was pTa, pT1, pT2, pT3 and pT4 in 4.9%, 22.8%, 25.2%, 44.7% and 1.6% of patients, respectively. The sensitivity of a selective urine cytology test was higher in the pure/primary CIS group than in the concomitant CIS group (60.0% vs 37.4%). At a median followup of 32 months 10-year estimated mean cancer specific survival was 92.4 months (range 83.7 to 101.0) in the overall CIS cohort. Ten-year estimated mean cancer specific survival in patients with pure/primary CIS was significantly longer than in patients with concomitant carcinoma in situ (111.8 months, range 101.0 to 122.6 vs 85.89, range 75.3 to 96.5, log rank p = 0.007). Conclusions: Patients presenting with concomitant CIS have a worse outcome than those who present with pure/primary CIS, suggesting a need to differentiate these 2 entities in the treatment decision process. References 1 : Impact of tumour size on prognosis of upper urinary tract urothelial carcinoma after radical nephroureterectomy: a multi-institutional analysis of 795 cases. BJU Int2016; 118: 902. Google Scholar 2 : Diagnostic dilemmas in patients with upper tract urothelial carcinoma. Nat Rev Urol2017; 14: 181. Google Scholar 3 : Prognostic factors in laser treatment of upper urinary tract urothelial tumours. J Med Life2012; 5: 33. Google Scholar 4 : Laser ablation of renal pelvic transitional cell carcinoma in a solitary kidney: a 9-year follow-up. Urology1996; 48: 298. Google Scholar 5 : Ureterorenoscopy for upper tract urothelial carcinoma: how often are we missing lesions?. Urology2015; 85: 311. Google Scholar 6 : Upper urinary tract carcinoma in situ: current knowledge, future direction. J Urol2017; 197: 287. Link, Google Scholar 7 : New technologies for upper tract urothelial carcinoma management. Curr Opin Urol2017; 27: 170. Google Scholar 8 : Risk group stratification based on preoperative factors to predict survival after nephroureterectomy in patients with upper urinary tract urothelial carcinoma. Ann Surg Oncol2013; 20: 4389. Google Scholar 9 : Antegrade perfusion with bacillus Calmette-Guerin in patients with non-muscle-invasive urothelial carcinoma of the upper urinary tract: who may benefit?. Eur Urol2011; 60: 955. Google Scholar 10 : Long-term effects of bacille Calmette-Guerin perfusion therapy for treatment of transitional cell carcinoma in situ of upper urinary tract. Urology2004; 63: 1084. Google Scholar 11 : Durable response of a carcinoma in situ of the renal pelvis to topical bacillus Calmette-Guerin. J Urol1985; 134: 531. Link, Google Scholar 12 : Intravesical instillation of bacille Calmette-Guerin for carcinoma in situ of the urothelium involving the upper urinary tract using vesicoureteral reflux created by a double-pigtail catheter. Urology2002; 59: 53. Google Scholar 13 : Clinical outcome of bacillus Calmette-Guerin perfusion therapy for carcinoma in situ of the upper urinary tract. Int J Urol2002; 9: 677. Google Scholar 14 : Bacillus Calmette-Guerin instillation treatment for carcinoma in situ of the upper urinary tract. BJU Int2000; 85: 799. Crossref, Medline, Google Scholar 15 : Bacillus Calmette-Guerin perfusion therapy for the treatment of transitional cell carcinoma in situ of the upper urinary tract. Eur Urol2000; 38: 701. Crossref, Medline, Google Scholar 16 : Intrarenal bacillus Calmette-Guerin therapy for carcinoma in situ of the upper urinary tract: long-term follow-up and natural course in cases of failure. BJU Int2001; 88: 343. Google Scholar 17 : Outcomes of intrarenal bacillus Calmette-Guerin/interferon-alpha2B for biopsy-proven upper-tract carcinoma in situ. J Endourol2012; 26: 1645. Google Scholar 18 : Concomitant carcinoma in situ as an independent prognostic parameter for recurrence and survival in upper tract urothelial carcinoma: a multicenter analysis of 772 patients. World J Urol2011; 29: 487. Google Scholar 19 : Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ confined urothelial carcinoma following radical nephroureterectomy. Urol Oncol2012; 30: 252. Google Scholar 20 : Clinical outcomes of primary bladder carcinoma in situ in a contemporary series. J Urol2010; 184: 74. Link, Google Scholar 21 : Clinical outcome of primary versus secondary bladder carcinoma in situ. J Urol2010; 184: 464. Link, Google Scholar 22 : Prognostic effect of urinary bladder carcinoma in situ on clinical outcome of subsequent upper tract urothelial carcinoma. Urology2011; 77: 861. Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 199Issue 4April 2018Page: 933-939 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordsureterkidneycarcinoma in situurotheliumprognosisMetricsAuthor Information Teruo Inamoto Department of Urology, Osaka Medical College, Takatsuki, Japan More articles by this author Hideyasu Matsuyama Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan More articles by this author Naokazu Ibuki Department of Urology, Osaka Medical College, Takatsuki, Japan More articles by this author Kazumasa Komura Department of Urology, Osaka Medical College, Takatsuki, Japan More articles by this author Kiyoshi Takahara Department of Urology, Osaka Medical College, Takatsuki, Japan More articles by this author Kiyohide Fujimoto Department of Urology, Nara Medical University, Kashihara, Japan More articles by this author Hiroaki Shiina Department of Urology, Shimane University School of Medicine, Izumo, Japan More articles by this author Shigeru Sakano Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan More articles by this author Kazuhiro Nagao Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan More articles by this author Makito Miyake Department of Urology, Nara Medical University, Kashihara, Japan More articles by this author Yoshihiro Tatsumi Department of Urology, Nara Medical University, Kashihara, Japan More articles by this author Hiroaki Yasumoto Department of Urology, Shimane University School of Medicine, Izumo, Japan More articles by this author Haruhito Azuma Department of Urology, Osaka Medical College, Takatsuki, Japan More articles by this author Nishinihon Uro-Oncology Collaborative Group More articles by this author Expand All Advertisement PDF downloadLoading ...