Yuasa Takeshi, Tsuchiya Norihiko, Narita Shintaro, Inoue Takamitsu, Saito Mitsuru, Kumazawa Teruaki, Horikawa Yohei, Matsuura Shinobu, Satoh Shigeru, Nanjo Hiroshi, Habuchi Tomonori
Department of Urology, Akita University School of Medicine, Akita, Japan.
Urology. 2006 Nov;68(5):972-5. doi: 10.1016/j.urology.2006.05.040. Epub 2006 Nov 7.
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.
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.
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.
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.
上尿路原位移行细胞癌（CIS）是一种相对罕见的疾病，治疗指南仍有待明确。在本研究中，我们评估了根治性肾输尿管切除术作为上尿路CIS初始治疗后的疗效。
1999年12月至2004年5月期间，8例经诊断为上尿路CIS后接受根治性肾输尿管切除术的患者纳入本研究。诊断标准包括：尿脱落细胞学检查阳性；膀胱多次随机活检阴性；包括逆行肾盂造影和计算机断层扫描在内的影像学检查阴性；以及选择性同侧尿液样本的系列细胞学检查结果阳性。
中位随访期为56个月。所有患者经病理证实均存在CIS。2例患者有更具侵袭性的病变（pT1和pT2），尽管回顾性评估未发现浸润性病变。5例患者出现膀胱内复发，其无复发生存期的中位数为16个月。这些异位尿路上皮复发不影响患者生存，在最后一次随访时，所有8例患者均无疾病存活。
尽管根治性肾输尿管切除术对一些上尿路CIS患者可能属于过度治疗，但仍可取得良好的生存结果。此外，应考虑到在相当一部分CIS患者的术前检查中无法识别的伴随侵袭性病变的存在。尽管本研究中的患者数量较少，但结果支持肾输尿管切除术应仍然是该疾病初始治疗的标准选择这一观点。
