Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain -
Department of Urology, Vita-Salute San Raffaele University, Milan, Italy -
Minerva Urol Nephrol. 2024 Feb;76(1):88-96. doi: 10.23736/S2724-6051.23.05593-3.
The optimal oncologic surveillance in patients with upper tract urothelial carcinoma (UTUC) elected for conservative treatment is still a matter of debate.
Patients elected for endoscopic treatment of UTUC were followed up according to EAU guidelines recommendations after treatment. Bladder cancer recurrence-free survival (BCa-RFS), UTUC recurrence-free survival (UTUC-RFS), radical nephroureterectomy-free survival (RNU-FS), and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. The crude risks of BCa and UTUC recurrences over time were estimated with the Locally Weighted Scatterplot Smoothing method.
Overall, 54 and 55 patients had low- and high-risk diseases, respectively. Median follow-up was 46.9 (IQR: 28.7-68.7) and 36.9 (IQR: 19.8-60.1) months in low and high-risk patients, respectively. In low-risk patients, BCa recurrence risk was more than 20% at 24 months follow-up. At 60 months, time point after which cystoscopy and imaging should be interrupted, the risk of BCa recurrence and UTUC recurrence were 14% and 7%, respectively. In high-risk patients, the risk of BCa and UTUC recurrence at 36 months was approximately 40% and 10%, respectively. Conversely, at 60 months, the risk of bladder recurrence and UTUC recurrence was 28% and 8%, respectively.
For low-risk patients, cystoscopy should be performed semi-annually until 24 months, while upper tract assessment should be obtained up to 60 months, as per current EAU guidelines recommendations. For high-risk patients, upper tract assessment should be intensified to semi-annually up to 36 months, then obtained yearly. Conversely, cystoscopy should be ideally performed semi-annually until 60 months and yearly thereafter.
对于选择保守治疗的上尿路尿路上皮癌（UTUC）患者，最佳的肿瘤监测方法仍存在争议。
根据 EAU 指南的建议，接受 UTUC 内镜治疗的患者在治疗后进行随访。使用 Kaplan-Meier 法估计膀胱癌无复发生存率（BCa-RFS）、UTUC 无复发生存率（UTUC-RFS）、根治性肾输尿管切除术无复发生存率（RNU-FS）和癌症特异性生存率（CSS）。使用局部加权散点平滑法估计随时间推移的膀胱癌和 UTUC 复发的粗风险。
总体而言，54 例和 55 例患者分别患有低危和高危疾病。低危和高危患者的中位随访时间分别为 46.9（IQR：28.7-68.7）和 36.9（IQR：19.8-60.1）个月。在低危患者中，BCa 复发风险在 24 个月随访时超过 20%。在 60 个月时，即应中断膀胱镜检查和影像学检查的时间点，BCa 复发和 UTUC 复发的风险分别为 14%和 7%。在高危患者中，36 个月时 BCa 和 UTUC 复发的风险分别约为 40%和 10%。相反，在 60 个月时，膀胱复发和 UTUC 复发的风险分别为 28%和 8%。
对于低危患者，根据当前 EAU 指南的建议，应每半年进行一次膀胱镜检查，直至 24 个月，而上尿路评估应持续至 60 个月。对于高危患者，上尿路评估应在前 36 个月每半年进行一次，然后每年进行一次。相反，膀胱镜检查理想情况下应每半年进行一次，直至 60 个月，之后每年进行一次。
