Upper Tract Urothelial Carcinoma (UTUC) Diagnosis and Risk Stratification: A Comprehensive Review

Abstract

Diagnosis and risk stratification are cornerstones of therapeutic decisions in the management of patients with upper tract urothelial carcinoma (UTUC). Diagnostic modalities provide data that can be integrated, to provide nomograms and stratification tools to predict survival and adverse outcomes. This study reviews cytology, ureterorenoscopy and the novel tools and techniques used with it (including photodynamic diagnosis, narrow-band imaging, optical coherence tomography, and confocal laser endomicroscopy), and biopsy. Imaging modalities and novel biomarkers are discussed in another article. Patient- and tumor-related prognostic factors, their association with survival indices, and their roles in different scores and predictive tools are discussed. Patient-related factors include age, sex, ethnicity, tobacco consumption, surgical delay, sarcopenia, nutritional status, and several blood-based markers. Tumor-related prognosticators comprise stage, grade, presentation, location, multifocality, size, lymphovascular invasion, surgical margins, lymph node status, mutational landscape, architecture, histologic variants, and tumor-stroma ratio. The accuracy and validation of pre-operative predictive tools, which incorporate various prognosticators to predict the risk of muscle-invasive or non-organ confined disease, and help to decide on the surgery type (radical nephroureterectomy, or kidney-sparing procedures) are also investigated. Post-operative nomograms, which help decide on adjuvant chemotherapy and plan follow-up are explored. Finally, a revision of the current stratification of UTUC patients is endorsed.

Same Organ, Two Cancers: Complete Analysis of Renal Cell Carcinomas and Upper Tract Urothelial Carcinomas

“…We identified an association between necrosis and acute intratumoral inflammatory infiltrate (p=0.008), but without a correlation between them and the systemic inflammatory syndrome (p=0.872). In the case of UTUC, a necrosis threshold of over 10% is associated with metastases and cancer deaths [88]. In our study, the presence of necrosis was not associated with the death of patients (p=0.461).…”

A Comprehensive Review on Upper Tract Urothelial Carcinoma: An Update in 2023

“…They also highlighted the role of artificial intelligence and multiomics in the classification and prognostication of UTUC. In another paper, Bitaraf et al reviewed other diagnostic tools (i.e., urine cytology and ureteroscopy), as well as patient-and disease-related prognostic factors that affect the outcomes of patients with UTUC [3]. They emphasized the substantial role of preoperative risk stratification tools and nomograms, which have been developed to guide surgical management and perioperative systemic therapy in UTUC.…”