Upper urinary tract involvement in patients with bladder carcinoma in situ (Tis): its impact on management.
OBJECTIVE
To analyze the biologic behavior and etiologic mechanism of upper-tract involvement in patients with bladder cancer in situ (Tis) and its impact on management of these patients.


METHODS
One hundred thirty-eight patients with bladder Tis, 786 with superficial bladder cancer, and 179 patients with invasive bladder cancer treated by cystectomy were studied: 34 (24.6%), 18 (2.3%), and 7 (3.9%) developed upper-tract involvement in each group, respectively. Sixty-three patients with primary urothelial upper-tract tumors were also studied. Taking progression-free survival as an end point, univariate and multivariate analyses were performed.


RESULTS
The upper-tract recurrence rate was significantly higher in patients with bladder Tis than in patients with superficial bladder tumors (P <0.001); it was also significantly higher in patients treated with cystectomy because of bladder Tis compared with those treated because of invasive tumors (P <0.01). Patients with bladder Tis and upper-tract involvement showed high rates of upper-tract bilaterality (32.3%) and prostate involvement (67.4%). On pathologic examination, the upper tract showed predominantly superficial (Ta-T1-Tis) tumors (67.4%) and distal ureter location as the only finding (47%). In patients with bladder Tis, upper-tract involvement alone does not have a negative impact on the survival rate according to univariate and multivariate analysis (P = NS).


CONCLUSIONS
In patients with bladder Tis, upper-tract involvement represents a diffuse process; therefore, a close evaluation of both the prostate and the upper tract is recommended. Upper-tract involvement has no impact on bladder-preservation strategy. Many of these patients could also be offered a conservative management for the involved upper tract.
Solsona
E
E
Department of Urology, Instituto Valenciano de Oncologia, Valencia, Spain.
Iborra
I
I
Ricós
J V
JV
Dumont
R
R
Casanova
J L
JL
Calabuig
C
C
D000368:Aged; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D014516:Ureteral Neoplasms / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy