Katayama Satoshi, Sasaki Katsumi, Kusumi Norihiro, Fujita Osamu, Kurose Kyohei, Ichikawa Takaharu, Takenaka Tadasu, Hashimoto Hideaki, Nakada Tetsuya, Arata Ryoji, Uematsu Katsutoshi, Yamamoto Yasuo, Nasu Yoshitsugu, Tsugawa Masaya, Yoshida Takashi, Sekito Takanori, Yoshinaga Kasumi, Yamanoi Tomoaki, Kawada Tatsushi, Tominaga Yusuke, Sadahira Takuya, Iwata Takehiro, Nishimura Shingo, Bekku Kensuke, Edamura Kohei, Kobayashi Tomoko, Kobayashi Yasuyuki, Watanabe Toyohiko, Araki Motoo
Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Urology, Kagawa Prefectural Central Hospital, Kagawa, Japan.
J Endourol. 2025 Sep 3. doi: 10.1177/08927790251374291.
To clarify disease behavior and oncological outcomes as well as the need for ureteroscopy (URS) implementation in patients with clinically suspected upper tract carcinoma (UT-CIS). In this multi-institutional study, we retrospectively analyzed patients who met three criteria for clinically suspected UT-CIS between 2008 and 2018: positive high-grade cytology from the upper tract, absence of a solid upper tract lesion on imaging, and negative bladder biopsy. Patients who underwent URS were compared with those who did not. Kaplan-Meier curve was used to assess the natural history of treated UT-CIS and the prognostic impact of URS. In total, 48 patients with clinically suspected UT-CIS were analyzed, of whom 27 (57%) had a previous history of urothelial carcinoma. Of 28 (58%) patients who underwent URS, pathologically confirmed UT-CIS and UT-non-CIS were detected in 7 (25%) and 6 (21%), respectively. As initial treatment, 23 (48%) patients received upper tract bacillus Calmette-Guérin, while 21 (44%) underwent radical nephroureterectomy (RNU). During a median follow-up of 44.8 months, the most common site that suffered recurrence and progression was the bladder (40% and 17%), followed by the affected (15% and 6%) and contralateral (8% and 4%) upper tract, respectively. Three-year overall, cancer-specific, upper tract-specific, progression-free (PFS), and recurrence-free survival estimates were 88.2%, 94.8%, 100%, 80.8%, and 52.4%, respectively. Survival outcomes were comparable regardless of URS implementation, with the exception of PFS. However, URS implementation resulted in an earlier transition to surgical intervention in 11% and avoided unnecessary RNU in 11%. UT-CIS is a pan-urothelial disease and frequently shows metachronous recurrence and progression in any part of the urinary tract, necessitating long-term, meticulous follow-up. Despite the lack of a statistical difference between patients with and without URS, we found that a non-negligible number of patients benefited from URS implementation.
