title: Grading of urothelial carcinoma of the upper urinary tract according to the World Health Organization/International Society of Urological Pathology classification from 2004 is a valuable tool when considering whether a patient is suitable for endoscopic treatment.
abstract: Objective The aim of this study was to analyse the results regarding survival, recurrence and kidney preservation after endoscopic treatment for upper urinary tract urothelial carcinoma (UTUC) in a Norwegian hospital during the period from 2001 to 2012, and compare them with results reported in the literature. A further aim was to re-examine all initial histopathological specimens, and stratify primary results according to the World Health Organization/International Society of Urological Pathology grading system of urothelial carcinoma from 2004. Materials and methods Forty-three patients were treated endoscopically with curative intent for UTUC during 2001-2012. Of these, 28 patients were candidates for nephroureterectomy (CNU) with an elective indication, while 15 were non-candidates for nephroureterectomy (NCNU). Analyses were performed separately for the CNU and NCNU groups. Results In the CNU group, the 5 year overall and disease-specific survival (OS and DSS) were 71% and 94%, respectively. In the NCNU group, the OS and DSS were 25% and 41%, respectively. Histopathological verification was available in 40 patients (93%), and re-examination showed 27 low-grade and 13 high-grade tumours. In patients with a low-grade tumour, the OS and DSS were 75% and 96%, respectively. In patients with a high-grade tumour, the OS and DSS were 23% and 39%, respectively. The 5 year kidney protection rate was 51% in the CNU group. The 5 year recurrence-free survival was 72%. Conclusions The endoscopic treatment of UTUC is feasible and safe in histopathologically verified low-grade tumours. The endoscopic treatment of high-grade tumours has poor results, and must be reserved for patients where nephroureterectomy is truly contraindicated.
authors.affiliation: a Department of Urology , Haukeland University Hospital , Bergen , Norway ;
authors.forename: Bjarte
authors.initials: B
authors.lastname: Almås
authors.affiliation: b Department of Pathology , Haukeland University Hospital , Bergen , Norway ;|c Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology , University of Bergen , Bergen , Norway ;
authors.forename: Ole J
authors.initials: OJ
authors.lastname: Halvorsen
authors.affiliation: a Department of Urology , Haukeland University Hospital , Bergen , Norway ;
authors.forename: Peder
authors.initials: P
authors.lastname: Gjengstø
authors.affiliation: a Department of Urology , Haukeland University Hospital , Bergen , Norway ;
authors.forename: Øyvind
authors.initials: Ø
authors.lastname: Ulvik
authors.affiliation: a Department of Urology , Haukeland University Hospital , Bergen , Norway ;|d Department of Clinical Medicine , University of Bergen , Bergen , Norway.
authors.forename: Christian
authors.initials: C
authors.lastname: Beisland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009392:Nephrectomy; D018579:Patient Selection; D012955:Societies, Medical; D015996:Survival Rate; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018666:Ureteroscopy; D014572:Urology; D014944:World Health Organization
keywords: Percutaneous renal surgery; upper urinary tract; ureteroscopy; urological oncology; urothelial cancer