Department of Urology, Osaka Medical College, Takatsuki, Japan.
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan.
J Urol. 2018 Apr;199(4):933-939. doi: 10.1016/j.juro.2017.10.019. Epub 2017 Oct 14.
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.
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.
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).
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.
患有尿路上皮癌 CIS（原位癌）的患者一般预后较差。然而，据我们所知，单纯/原发性 CIS 的结果以及接受肾输尿管切除术治疗的同时伴有 pTa-pT4 上尿路尿路上皮癌的 CIS 的行为尚未得到明确规定。我们探讨了同时伴有 CIS 与单纯/原发性 CIS 相比的生物学和预后特征。
我们查询了一个多中心上尿路尿路上皮癌数据库。分析了来自 NUOG（日本西部泌尿肿瘤组）的数据，包括患者的性别、年龄、膀胱癌的存在和 pT 分期。比较了不同亚型的临床病理特征。根据 CIS 亚型估计癌症特异性和总体生存率以及相对死亡风险增加。
我们在上尿路发现了 163 例 CIS 患者，其中单纯/原发性 CIS 占 24.5%。在同时伴有 CIS 的队列中，非 CIS 区域的病理诊断分别为 pTa、pT1、pT2、pT3 和 pT4 的患者占 4.9%、22.8%、25.2%、44.7%和 1.6%。选择性尿细胞学检查的敏感性在单纯/原发性 CIS 组中高于同时伴有 CIS 组（60.0% vs 37.4%）。在中位随访 32 个月时，整个 CIS 队列的 10 年估计平均癌症特异性生存率为 92.4 个月（范围 83.7 至 101.0）。单纯/原发性 CIS 患者的 10 年估计平均癌症特异性生存率明显长于同时伴有原位癌的患者（111.8 个月，范围 101.0 至 122.6 vs 85.89，范围 75.3 至 96.5，对数秩检验 p = 0.007）。
同时伴有 CIS 的患者比单纯/原发性 CIS 患者的预后更差，这表明在治疗决策过程中需要区分这两种实体。
