| 【Objective】To analyze and summarize the clinical characteristics of asymptomatic upper urinary tract epithelial carcinoma,including its diagnosis and treatment.【Materials and methods】Clinical data of 136 patients of surgically treated upper tract urothelial carcinoma were retrospective analyzed from the urological department of fujian provincial hospital and fujian jinshan provincial hospital from January 2012 to January 2018.Among 136 patients,21 patients of asymptomatic upper urinary tract epithelial carcinoma were included in group(A),and other115 patients of upper urinary tract epithelial carcinoma presented with hematuria or low back pain were included in group(B).Gender,age(years old),tumor size(max diameter in imagine),tumor location(pelvic tumors,ureteral tumor,renal pelvis tumor with ureteral tumor),urine cytology result,postoperative pathological stage,grade,lymphovascular invasion,and surgical methods of group A and B were compared and analyzed.At the same period,the clinical data of106 patients with asymptomatic bladder tumor were collected.31 cases of them were asymptomatic bladder urothelial carcinoma.The data of postoperative pathological staging and cytological grading between the asymptomatic UTUC group and the asymptomatic bladder cancer group were also compared and analyzed.【Results】Group A and B showed no statistical difference(P > 0.05)in gender,age(years old),imaging tumor size(max diameter),tumor location(pelvic tumors,ureteral tumor,renal pelvis tumor with ureteral tumor)and urine cytology result.In this study,55 patients underwent ureteroscopy/flexible ureteroscopy and biopsy before or during operation,including 20 patients in group A and 35 patients in group B.12 patients in group A underwent biopsy and pathological considerations for malignant urothelial tumors.Among them,8 cases were graded G1,2 cases were graded G2,and 2 cases were graded G3.8 cases underwent biopsy of intraoperative tumors,of which 7 cases were considered malignant urothelial tumors with pathological considerations,and 1 case could not determine the nature of the tumor.In group B,18 patients underwent preoperative tumor biopsy and pathological considerations for malignant urothelial tumors.The tumor grade was 13 cases in G1 stage,3 cases in G2 stage,and 2 cases in G3 stage.17 cases underwent biopsy of intraoperative tumors,of which 15 cases were considered to be malignant urothelial tumors in pathological considerations,and 2 cases could not determine the nature of the tumor.Of the 5 patients with stage G2,2 patients underwent holmium laser resection of pelvis tumors under flexible ureteroscopy.The postoperative pathology was upgraded to high grade(G3).Three patients underwent radical surgery.One of them had postoperative pathological upgrade to high grade(G3),and two cases were consistent with the grade of intraoperative pathological biopsy.The pathological grade of the remaining tumor biopsies was the same as that of the postoperative tumor.In group A,80.95%(17/21)patients were selected for radical nephroureterectomy surgery.14.29%(3/21)underwent partial ureterectomy and reanastomosis/ureter reimplantation.4.76%(1/21)underwent flexible ureteroscopic holmium laser resection of renal pelvis carcinoma.In group B(presented with hematuria,low back pain),90.43%(104/115)patients were selected for radical nephroureterectomy surgery.7.83%(9/115)underwent partial ureterectomy and ureteroneocystostomy.1.74%(2/115)underwent flexible ureteroscopic holmium laser resection of renal pelvis carcinoma.Postoperative pathology in group A included 9 cases of renal pelvis carcinoma,11 cases of ureteral carcinoma,and 1 case of renal pelvis carcinoma concurrent with ureteral carcinoma.8 cases of them showed invasion microvascalar.There were none case of pathological stage Ta N0M0,5 cases of T1N0M0,5 cases of T2N0M0,6 cases of T3N0M0,3cases of T3N1M0,1 case of T4N0M0 and 1 case of T4N1M0 in group A.Regarding tumor grade,8 were Low-grade(LG)papillary urothelial carcinoma,and 13 were high-grade(HG)papillary urothelial carcinoma.Among the 115 cases of in group B included 67 cases of renal pelvis carcinoma,41 cases of ureteral carcinoma,and 7 cases of renal pelvis carcinoma concurrent with ureteral carcinoma.Postoperative pathology revealed microvascular invasion in22 cases.The pathological stages included 1 case of Ta N0M0 stage,28 cases of T1N0M0 stage,35 cases of T2N0M0 stage,27 cases of T3N0M0 stage,12 cases of T3N1M0 stage,10 cases of T4N0M0 stage,1 case of T4N1M0 stage and 1 case of T4N1M1 stage.64 cases had low-grade(LG)papillary urothelial carcinoma,51 cases had high-grade(HG)papillary urothelial carcinoma.There was no statistically significant difference between group A and group B in the choice of surgical methods,lymphovascular invasion and pathological stage and grade(P>0.05).The mean follow up time of asymptomatic group A was 33.62±15.52(14-70)months,and that of group B was 39.57±21.80(12-81)months.In group A,6 of 21 patients lost follow-up,there were 11 patients without recurrence,3 patients with bladder recurrence,2 patients died(1patient died of tumor recurrence and 1 patient died of unknown cause),.Recurrence rate was21.43%(3/14).Cancer specific mortality rate was 7.14%(1/14).Overall mortality rate was13.33 %(2/15).In group B,16 of 115 patients lost follow-up,there were 80 patients alive without recurrence.18 patients suffered bladder tumor recurrence(three of them had lung metastasis at the same time),7 patients died(five of them died of tumor recurrence,one of them died due to other causes,and one of them had no known cause of death).Recurrence rate was18.37%(18/98).Tumor specific mortality rate was 5.10 %(5/98).Overall mortality rate was7.07%(7/99).In addition,the clinical data of 106 patients with asymptomatic bladder tumor were collected and analyzed at the same period,including 31 cases of asymptomatic bladder urothelial carcinoma.We found that most of asymptomatic bladder urothelial carcinoma cases were low stage and low grade tumors.Postoperative pathological staging revealed Ta N0M0 in25 cases and T1N0M0 in urothelial carcinoma in 2 cases.Compared with asymptomatic bladder urothelial carcinoma group,postoperative pathological staging and cytological classification showed that the asymptomatic UTUC group had higher stage and grade urothelial carcinoma and was more aggressive.The difference between the two groups was statistically significant(P< 0.05).【Conclusions】Compared with asymptomatic bladder cancer,asymptomatic UTUC is more malignant and more aggressive.However,compared with asymptomatic UTUC,asymptomatic UTUC does not show a lower grade of staging and should be taken seriously.For high-risk groups,active imaging is necessary,especially for repeated microscopic hematuria or hydronephrosis of unknown cause.Surgery is the key to UTUC treatment.Full-length renal ureterectomy+bladder sleeve resection is the gold standard.Kidney-retaining surgery can be used for low-risk and low-risk tumor patients.The principle of asymptomatic UTUC treatment is the same as that of symptomatic UTUC.Risk stratification should be carried out according to clinical staging and other parameters,and the corresponding surgical treatment should be selected.Preoperative or intraoperative ureteroscopy/flexible ureteroscopy is not generally used as a routine method for asymptomatic UTUC preoperative diagnosis.It is mainly used for patients with unknown tumor properties and who need pathological examination to provide a basis for the choice of surgical method or isolated kidney. |
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