Biologic behavior and long-term outcomes of carcinoma in situ in upper urinary tract managed by radical nephroureterectomy

Carcinoma in situ (CIS) in urothelial carcinoma generally has poor prognosis, but the outcomes of pure/primary CIS tumor (p-CIS) and the behavior of concomitant CIS (c-CIS) with pTa-pT4 upper tract urothelial carcinoma (UTUC) managed by nephroureterectomy has not been specified. The aim of our study was to explore the biological and prognostic features of c-CIS, compared with p-CIS.

We queried multicenter UTUC database. Data from the Nishinihon Uro-Oncology Group (NUOG), including gender, age, presence of bladder cancer, pT stage, were analyzed. Clinico-pathological features were compared between different subtypes. Cancer specific survival (CSS) and overall survival (OS) and relative excess risk of death were estimated by CIS subtype.

A total of 163 patients with CIS in the upper urinary tract were identified. Of these, p-CIS was noted in 24.5% of the patients. In c-CIS cohort, pathological diagnosis for non-CIS region was pTa, pT1, pT2, pT3 and pT4 in 4.9%, 22.8%, 25.2%, 44.7% and 1.6%, respectively. Sensitivity of selective urine cytology test was higher in the p-CIS group compared to c-CIS group (60.0 vs. 37.4%). After a median follow-up of 32 months, the 10-year estimated mean CSS was 92.4 months (83.7-101.0) for overall CIS cohort. The 10-year estimated mean CSS of p-CIS patients (111.8 months, 101.0-122.6) was significantly longer than that of c-CIS (85.89 months, 75.3-96.5; Log rank p=0.007).

Patients presenting with c-CIS have a worse outcome than those with p-CIS, suggesting a need to differentiate these two entities in the treatment decision process.

The Journal of urology. 2017 Oct 13 [Epub ahead of print]

Teruo Inamoto, Hideyasu Matsuyama, Naokazu Ibuki, Kazumasa Komura, Kiyoshi Takahara, Kiyohide Fujimoto, Hiroaki Shiina, Shigeru Sakano, Kazuhiro Nagao, Makito Miyake, Yoshihiro Tatsumi, Hiroaki Yasumoto, Haruhito Azuma, Nishinihon Uro-Oncology Collaborative Group

Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan. Electronic address: ., Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan. Electronic address: ., Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan. Electronic address: ., Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan. Electronic address: ., Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan. Electronic address: ., Department of Urology, Nara Medical University, Kashihara, Nara, Japan. Electronic address: ., Department of Urology, Shimane University School of Medicine, Izumo, Shimane, Japan. Electronic address: ., Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan. Electronic address: ., Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan. Electronic address: ., Department of Urology, Nara Medical University, Kashihara, Nara, Japan. Electronic address: ., Department of Urology, Nara Medical University, Kashihara, Nara, Japan., Department of Urology, Shimane University School of Medicine, Izumo, Shimane, Japan. Electronic address: ., Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan. Electronic address: .