The Academic Department of Urology of Tenon and of Pitié-Salpétrière, Groupe Hospitalo-Universitaire EST, Assistance-Publique Hôpitaux de Paris.
World J Urol. 2010 Apr;28(2):151-6. doi: 10.1007/s00345-009-0494-x. Epub 2010 Jan 1.
To assess oncological outcome after first-line management of upper urinary tract urothelial cell carcinomas (UUT-UCCs) by exclusive flexible ureteroscopy.
A retrospective review was performed for 35 patients treated between 2003 and 2007. All patients underwent retrograde flexible ureteroscopy for diagnosis, treatment (i.e., holmium:YAG vaporisation), and follow-up. The following data were reviewed: sex, age, ASA score, presence of a solitary kidney, unifocal or multifocal tumour, history of bladder cancer, tumour localisation, tumour size, stage and grade, outcome, recurrence, and progression.
The mean age was 67 + or - 13.1 years (range: 38-88). The tumour involved the renal pelvis and the caliceal system in 19 cases (54%), the ureter in 8 cases (23%), and both in 8 cases (23%). Twelve patients (34%) had a history of bladder carcinoma. Tumour stage was superficial in 63% (57% were pTa and 6% were pT1) and not available in 37%. Tumour grade was low, high, and unavailable in 49, 14, and 37%, respectively. The median follow-up was 30 months (range: 12-66), and 21 patients had a recurrence (60%). The median survival rate without recurrence was 10 months (95% CI [5-22]). Four patients underwent nephroureterectomy during follow-up. No patient died of disease progression. The main limitation was the limited length of follow-up.
Flexible endoscopic management can be advocated in selected cases of non-muscle invasive UUT-UCCs as an alternative to nephroureterectomy. Because of a high recurrence rate, long-term and stringent surveillance is needed, including iterative ureteroscopies at least every 3 months for 2 years.
评估单纯软性输尿管镜治疗上尿路尿路上皮细胞癌（UUT-UCC）一线治疗的肿瘤学结果。
对 2003 年至 2007 年间治疗的 35 例患者进行回顾性研究。所有患者均接受逆行软性输尿管镜检查以进行诊断、治疗（即钬：YAG 汽化）和随访。回顾以下数据：性别、年龄、ASA 评分、是否存在孤立肾、单发病灶或多发病灶、膀胱癌病史、肿瘤位置、肿瘤大小、分期和分级、结果、复发和进展。
平均年龄为 67+或-13.1 岁（范围：38-88）。19 例（54%）患者肿瘤累及肾盂和肾盏系统，8 例（23%）累及输尿管，8 例（23%）累及两者。12 例（34%）有膀胱癌病史。肿瘤分期为浅表性占 63%（57%为 pTa，6%为 pT1），无法评估占 37%。肿瘤分级为低级别、高级别和无法评估分别占 49%、14%和 37%。中位随访时间为 30 个月（范围：12-66），21 例患者复发（60%）。无复发的中位生存率为 10 个月（95%CI[5-22]）。4 例患者在随访期间接受了肾输尿管切除术。无患者死于疾病进展。主要限制是随访时间有限。
在选择的非肌肉浸润性 UUT-UCC 病例中，软性内镜治疗可以替代肾输尿管切除术。由于复发率高，需要长期严格监测，包括至少每 3 个月进行一次输尿管镜检查，持续 2 年。
