Long-term outcome of upper urinary tract carcinoma in situ: effectiveness of nephroureterectomy versus bacillus Calmette-Guérin therapy.
BACKGROUND
We examined the long-term outcome and compared the usefulness of nephroureterectomy with that of bacillus Calmette-Guérin (BCG) therapy for the management of upper urinary tract carcinoma in situ (CIS).


METHODS
We retrospectively reviewed the post-treatment course of 17 patients with CIS of the upper urinary tract who had undergone either a nephroureterectomy (group A, n = 6) or BCG therapy (group B, n = 11) at our institute.


RESULTS
Median follow up was 58.3 months (range 1-120 months). Four of the six patients in group A (67%) had no recurrence and remained cystoscopically, cytologically and radiographically free of disease. The cytology became negative after an 8-week course in nine of the eleven patients in group B (82%; eight of ten units, 77%). Two of the nine patients showed recurrence after BCG therapy. One patient died of respiratory failure caused by a side-effect of BCG, which was interstitial pneumonia. There was no significant difference in either the 5-year recurrence-free survival or the 5-year cancer-specific survival between groups A and B.


CONCLUSIONS
BCG therapy for CIS of the upper urinary tract is as effective as nephroureterectomy in long-term outcome, although it has some dangerous aspects. Further experience with treatment of CIS of the upper urinary tract is required.
Kojima
Yoshiyuki
Y
Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. ykojima@med.nagoya-cu.ac.jp
Tozawa
Keiichi
K
Kawai
Noriyasu
N
Sasaki
Shoichi
S
Hayashi
Yutaro
Y
Kohri
Kenjiro
K
D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000368:Aged; D001500:BCG Vaccine / Q000627:therapeutic use*; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003558:Cystoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D014567:Urography
D000276:Adjuvants, Immunologic; D001500:BCG Vaccine