Upper Urinary Tract Carcinoma in Situ: Current Knowledge, Future Direction

Carcinoma in situ of the urinary tract is a high-grade form of non-muscle invasive urothelial carcinoma, with poor understanding of this entity in the upper tract (UTCIS). Patient management remains challenging due to knowledge gaps regarding the definition, diagnosis, treatment options, and follow up of disease. We review the available literature for similarities and differences between bladder and upper tract CIS summarizing the best available data.

Thorough review of PubMed and MEDLINE databases was performed from January 1976 through September 2014. The Preferred Reporting Items for Systematic Review and Meta-analysis statement was utilized to screen publications. All authors participated in the development of a consensus definition of disease.

61 publications were found suitable for this review. All studies are retrospective. UTCIS appears to have lower progression rates and improved survival compared to bladder CIS. All available studies find topical therapy effective in treating UTCIS with lower recurrence rates compared to bladder CIS. Highlighted areas of current knowledge gaps include variable definitions of disease, methods of drug delivery, and ideal treatment course. Improving methods for detection may allow for easier diagnosis and more effective treatment.

Based on available data organ preserving therapy with topical agents is an alternative to radical surgery in select patients with UTCIS, but this has not been evaluated in prospective trials. A paradigm shift regarding detection and treatment is needed to truly improve care and confidently allow better renal preservation. A consensus definition of the disease is suggested, and several areas of major knowledge gaps and thus opportunities for future research are identified.

The Journal of urology. 2016 Sep 21 [Epub ahead of print]

Grant P Redrow, Charles C Guo, Maurizio A Brausi, Jonathan A Coleman, Mario I Fernandez, Wassim Kassouf, Francis X Keeley, Vitaly Margulis, Jay D Raman, Morgan Roupret, Shahrokh F Shariat, Philippe E Spiess, George N Thalmann, Surena F Matin

Dept. Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA; Div. Urology, University of Texas at Houston School of Medicine, Houston, TX, USA., Dept. Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Ausl Modena, Nuovo Ospendale Civile - S. Agostino Estense, Modena, Italy., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY., Dept. of Urology, Clinica Alemana de Santiago, Santiago, Chile., Div Urology McGill University Health Center., Bristol Urological Institute, Southmead Hospital, Bristol, UK., Dept. Urology, U.T. Southwestern Medical Center, Dallas, TX, USA., Div. Urology Penn State Milton S. Hershey Medical Center, Hersey, PA, USA., Department of Urology, Groupe Hospitalier Pitié - Salpêtrière, Assistance Publique Hopitaux de Paris, Faculty of Medicine Pierre et Marie Curie, Institut Universitaire de Cancérologie GRC5, University Paris 6, Paris, France., Dept of Urology and Comprehensive Cancer Center Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Dept. of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA., Department of Urology, University of Bern, Inselspital, Bern, Switzerland., Dept. Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.