上部尿路上皮癌に対する術前尿管鏡検査の有用性についての検討

<p>  Introduction : Upper tract urothelial carcinoma is difficult to diagnose and stage accurately before surgical treatment. Although ureteroscopy and ureteroscopic tumor biopsy are useful tools for the definitive diagnosis of upper urinary tract carcinoma, there is concern about the risks of tumor dissemination and intravesical recurrence. In this study, we examined the usefulness of preoperative ureteroscopy.</p><p>  Patients and Methods : Data of 177 patients diagnosed with upper tract urothelial carcinoma who underwent nephroureterectomy at our hospital between January 2004 and January 2018 were retrospectively reviewed. We compared the preoperative ureteroscopy group and without ureteroscopy group, analyzed the influence on oncological outcomes, and examined the correspondence between the biopsy grade and pathological stage.</p><p>  Results : A total of 125 (70.6％) patients underwent preoperative ureteroscopy, and 52 (29.7％) did not undergo ureteroscopy. The preoperative non-ureteroscopy group was significantly correlated with a high complication rate of gross-hematuria and an advanced clinical T stage (P＝0.033 and P＝0.007, respectively). The waiting period for surgery in the ureteroscopy group was significantly longer than in the non-ureteroscopy group (66 days vs. 51.5 days, respectively, P＜0.001). However, there was no significant difference between the two groups in terms of the overall, recurrence-free and intravesical recurrence-free survival rates (P＝0.426, P＝0.766, and P＝0.809, respectively). According to the 91 patients undergoing ureteral tumor biopsy, the patients with biopsy grade 3 were significantly more likely to have invasive cancer (pT3 or more) compared with patients with biopsy grade 1 or 2 (P＝0.004).</p><p>  Discussion : Preoperative ureteroscopy significantly prolongs the waiting period for surgical treatment, but does not increase the rate of a poor prognosis or intravesical recurrence. Therefore, in cases where neoadjuvant chemotherapy and kidney-sparing surgery are considered, preoperative ureteroscopy may be a useful supplementary test when it is difficult to decide on the diagnosis and treatment based on imaging alone.</p>