論文種別	原著(症例報告除く)
言語種別	英語
査読の有無	その他(不明)
表題	Outcome and Impact of Diagnostic Ureteroscopy in Clinically Suspected Upper Urinary Tract Carcinoma in Situ.
掲載誌名	正式名：Journal of endourology 略　 称：J Endourol ISSNコード：1557900X/08927790
掲載区分	国外
巻・号・頁	39(11),pp.1115-1124
著者・共著者	Satoshi Katayama, Katsumi Sasaki, Norihiro Kusumi, Osamu Fujita, Kyohei Kurose, Takaharu Ichikawa, Tadasu Takenaka, Hideaki Hashimoto, Tetsuya Nakada, Ryoji Arata, Katsutoshi Uematsu, Yasuo Yamamoto, Yoshitsugu Nasu, Masaya Tsugawa, Takashi Yoshida, Takanori Sekito, Kasumi Yoshinaga, Tomoaki Yamanoi, Tatsushi Kawada, Yusuke Tominaga, Takuya Sadahira, Takehiro Iwata, Shingo Nishimura, Kensuke Bekku, Kohei Edamura, Tomoko Kobayashi, Yasuyuki Kobayashi, Toyohiko Watanabe, Motoo Araki,
発行年月	2025/11
概要	Objectives: To clarify disease behavior and oncological outcomes as well as the need for ureteroscopy (URS) implementation in patients with clinically suspected upper tract carcinoma in situ (UT-CIS). Patients and Methods: 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. Results: 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%. Conclusions: 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.
DOI	10.1177/08927790251374291
PMID	40899324