Radical nephroureterectomy as initial treatment for carcinoma in situ of upper urinary tract.

OBJECTIVES

Transitional cell carcinoma in situ (CIS) of the upper urinary tract is a relatively rare disease, and treatment guidelines remain to be defined. In this study, we evaluated the outcomes after radical nephroureterectomy as the initial therapy for upper urinary tract CIS.

METHODS

Eight patients treated with radical nephroureterectomy after the diagnosis of upper urinary tract CIS from December 1999 to May 2004 were entered in this study. The diagnosis criteria included positive voided urinary cytology; negative multiple random biopsies of the bladder; negative radiographic studies, including retrograde pyelography and computed tomography; and serial positive cytology results in selective ipsilateral urine samples.

RESULTS

The median follow-up period was 56 months. The presence of CIS was confirmed pathologically in all patients. Two patients had more invasive lesions (pT1 and pT2), although retrospective evaluation revealed no infiltrative lesions. Intravesical recurrence was found in 5 patients, whose median recurrence-free period was 16 months. These heterotopic urothelial recurrences did not affect patient survival, and all 8 patients were alive without disease at last follow-up.

CONCLUSIONS

Although radical nephroureterectomy may be overtreatment for some patients with upper urinary tract CIS, excellent survival outcomes can be accomplished. In addition, the presence of concomitant invasive lesions, which cannot be identified on pretreatment examination in a substantial subset of patients with CIS, should be taken into account. Although the number of patients in this study was small, the results support the view that nephroureterectomy should remain a standard option for the initial treatment of this disease.