Therapeutic strategies for asymptomatic upper urinary tract urothelial carcinoma.

ABSTRACT

Introduction: Upper urinary tract epithelial carcinoma (UTUC) and bladder cancer are both sources of urinary epithelial cell. In our previous study of asymptomatic bladder tumors, we found that most of these tumors could be resected through the urethra without radical surgery. This study analyzed the treatment strategies for asymptomatic UTUC. Aim: To investigate the clinicopathological features and surgical methods of these patients, thus choosing appropriate surgical treatment. Material and methods: 136 patients with UTUC were recruited, of whom 21 patients with asymptomatic UTUC were group A, and 115 UTUC patients with hematuria or low back pain were group B. The clinicopathological features, oncologic outcomes, and surgical methods of patients were evaluated. Results: Radical resection was the main surgical treatment which was included (group A 80.95%, group B 90.43%). Other patients were treated with kidney-retaining surgery. No statistically significant difference was observed in the pathological stage and grade between groups A and B (p > 0.05). During a median follow-up period of 44.3 months, tumor-specific mortality of group A was 7.14%, and that of group B was 5.10%. In the same period, 106 patients with asymptomatic bladder tumor were recruited 31 patients of them had asymptomatic bladder urothelial carcinoma. The asymptomatic UTUC group had a higher stage and grade of clinicopathological features than the asymptomatic bladder urothelial carcinoma group (p < 0.001). Conclusions: 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.