European Guidelines on Upper Tract Urothelial Carcinomas: 2013 Update

Rouprêt, Morgan; Babjuk, Marko; Compérat, Éva; Zigeuner, Richard; Sylvester, Richard; Burger, Max M.; Cowan, Nigel C.; Böhle, Andreas; Rhijn, Bas W.G. van; Kaasinen, Eero; Palou, Joan; Shariat, Shahrokh F.

doi:10.1016/j.eururo.2013.03.032

Cited by 432 publications

(427 citation statements)

References 145 publications

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“…Recurrence of disease in the bladder occurs in 22-47% of UTUC patients, whereas recurrence in the contralateral upper tract is observed in 2-6% [7]. Compared to UC of the bladder, UTUC is often more advanced at initial diagnosis with almost 60% invasive at diagnosis, presents at a higher grade, and consequently, has a poorer prognosis [8,9]. UTUC shares similar risk factors with bladder cancer with tobacco and occupational exposure to aromatic amines being the most common [9].…”

Section: Epidemiologymentioning

confidence: 99%

“…Retrograde pyelograms may be included in the workup in cases of non-contrast computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound when collecting system detail is deemed imperative [18,19]. Cystoscopy should be performed as part of the hematuria evaluation [9,16,18,19]. If there is concern for metastatic disease, the workup should include complete blood count, basic metabolic panel, chest X-ray, and bone scan if elevated alkaline phosphatase or bone signs/symptoms present [19].…”

Section: Workupmentioning

confidence: 99%

“…These include cell adhesion (E cadherin and CD24), cell differentiation (Snail and epidermal growth factor receptor), angiogenesis (hypoxiainducible factor-1 alpha and metalloproteinases), cell proliferation (Ki67), epithelial mesenchymal transition (snail), mitosis (Aurora-A), apoptosis (Bcl-2 and survirin), and vascular invasion markers (recepteur d'origine nantais RON and c-met protein MET). To date, none of these markers have fulfilled the clinical and statistical criteria necessary to support their use in daily clinical decision-making, mainly as a result of disease rarity and small study sample sizes [9].…”

Section: ) Urine Samplingmentioning

confidence: 99%

“…Computed tomography urography (CTU) is the gold standard imaging modality, with other options including magnetic resonance urography (MRU), and re- Upper Tract Urothelial Carcinoma World J Nephrol Urol. 2015;4(2):189-200 nal ultrasound [9,16,18,19]. Retrograde pyelograms may be included in the workup in cases of non-contrast computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound when collecting system detail is deemed imperative [18,19].…”

Section: Workupmentioning

confidence: 99%

“…The most common presenting symptoms leading to diagnosis of UTUC is gross or microscopic hematuria in 56-98%, flank pain seen in 20-40%, and lumbar mass seen in 10-20% worldwide [9,16]. An additional 15% of patients do not experience symptoms of any kind and are identified following incidental abnormal imaging findings [17].…”

Section: Symptoms Upon Initial Presentationmentioning

confidence: 99%

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Contemporary Management and Trends in the Treatment of Upper Tract Urothelial Carcinoma

Abbott

Cicic

DiMatteo

et al. 2015

World J Nephrol Urol

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Upper tract urothelial carcinoma (UTUC) represents only 5% of all urothelial cancers. The 5-year cancer-specific survival in the United States is roughly 75%, with grade and stage being the most powerful predictors of survival. Nephroureterectomy with excision of the ipsilateral ureteral orifice and bladder cuff en bloc remains the gold standard treatment of the upper urinary tract urothelial cancers. However, endoscopic and laparoscopic approaches are rapidly evolving as reasonable alternatives of care depending on grade and stage of disease. A critical review of the current literature and various guidelines regarding tumor management in UTUC was undertaken, with a focus on surgical options. Topics reviewed include percutaneous and endoscopic approaches, laparoscopic nephroureterectomy (LNU), options regarding the management of the distal ureter, the role of lymphadenectomy, and the emerging role of chemotherapy in the treatment of UTUC. Both National Comprehensive Cancer Network (NCCN) and European Association of Urology (EAU) current guidelines are reviewed. Limited recommendations are provided by the American Urological Association (AUA). Scant level 1 or grade A evidence was noted in the establishment of the various guidelines. There is debate regarding how to best manage UTUC. With the current trend towards minimally invasive, localized, and precise surgical treatments for all solid malignancies, we must evaluate this movement as it applies to UTUC. Nephron sparing surgery is the preferred option, when feasible, in the management of other renal malignancies. This, too, must be considered when managing UTUC. Higher quality research is needed to better establish evidence-based guidelines. However, this is a challenging prospect given the low incidence of UTUC and the difficulties encountered in creating appropriate protocols.

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Section: Epidemiologymentioning

confidence: 99%

Section: Workupmentioning

confidence: 99%

Section: ) Urine Samplingmentioning

confidence: 99%

Section: Workupmentioning

confidence: 99%

Section: Symptoms Upon Initial Presentationmentioning

confidence: 99%

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Contemporary Management and Trends in the Treatment of Upper Tract Urothelial Carcinoma

Abbott

Cicic

DiMatteo

et al. 2015

World J Nephrol Urol

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Bladder and Other Urothelium

2017

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Summary Bladder cancer is a common disease, although its epidemiology differs around the world. Environmental and behavioural factors are important in its aetiology. Significant differences in the biology of different types of non‐muscle‐invasive bladder urothelial cancer, or differences between upper and lower tract cancers, have now been recognized. Management involves multidisciplinary engagement in terms of diagnosis, treatment of non‐muscle‐invasive disease, consideration of options for local control of invasive disease, and management of locally‐advanced or metastatic cancer or cancers of non‐urothelial histology. Significant opportunities remain for improvement of management and controversies continue with respect to issues of surgery, radiation and medical management.

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