Daneshmand Siamak, Quek Marcus L, Huffman Jeffry L
Department of Urology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
Cancer. 2003 Jul 1;98(1):55-60. doi: 10.1002/cncr.11446.
The efficacy and long-term results of endoscopic management of upper tract transitional cell carcinoma (TCC) were examined. The authors evaluated the accuracy of endoscopic biopsy in determining tumor grade in the subset of patients who underwent open surgical excision.
Between 1987 and 2001, 50 patients (17 with a solitary kidney) underwent ureteroscopy and biopsy of upper tract TCC. Eleven patients underwent ureterectomy or nephroureterectomy shortly after endoscopic biopsy. There was no follow-up for nine patients. Thirty patients underwent endoscopic ablation of their primary tumor with laser or electrofulguration at the time of the initial biopsy and were followed with close endoscopic surveillance at 3-4-month intervals.
For the 30 patients who underwent endoscopic ablation, mean follow-up was 38 months (range, 4-106 months). There was an average of 3.4 recurrences, with an average time to first recurrence of 7 months. Ten of the 30 patients underwent open resection during follow-up. Six patients exhibited tumor progression at follow-up. During the follow-up period, one patient died of recurrent disease, and six died of other causes. Endoscopic biopsy accurately predicted the tumor grade for 8 of the 9 patients who had open tumor resection within 2 months of their last biopsy and for 10 of the 11 patients who had open resection shortly after their initial endoscopic biopsy (overall accuracy, 18 of 20 [90%]).
Endoscopic treatment of focal low-grade TCC of the upper urinary tract is feasible and safe, provided that vigilant follow-up and endoscopic surveillance are performed. Endoscopic biopsy provides accurate information regarding tumor grade.
对输尿管镜治疗上尿路移行细胞癌（TCC）的疗效及长期结果进行了研究。作者评估了在接受开放性手术切除的患者亚组中，内镜活检在确定肿瘤分级方面的准确性。
1987年至2001年间，50例患者（其中17例为孤立肾）接受了输尿管镜检查及上尿路TCC活检。11例患者在内镜活检后不久接受了输尿管切除术或肾输尿管切除术。9例患者未进行随访。30例患者在初次活检时接受了激光或电灼对原发肿瘤的内镜下消融治疗，并每隔3 - 4个月接受密切的内镜监测。
对于接受内镜下消融治疗的30例患者，平均随访时间为38个月（范围4 - 106个月）。平均复发3.4次，首次复发的平均时间为7个月。30例患者中有10例在随访期间接受了开放性切除术。6例患者在随访时出现肿瘤进展。在随访期间，1例患者死于复发性疾病，6例死于其他原因。内镜活检准确预测了9例在最后一次活检后2个月内接受开放性肿瘤切除的患者中的8例以及11例在初次内镜活检后不久接受开放性切除的患者中的10例的肿瘤分级（总体准确率为20例中的18例[90%]）。
只要进行密切随访和内镜监测，上尿路局限性低级别TCC的内镜治疗是可行且安全的。内镜活检可提供有关肿瘤分级的准确信息。
