European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update |
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| Authors: | Morgan Rouprêt Marko Babjuk Maximilian Burger Otakar Capoun Daniel Cohen Eva M Compérat Nigel C Cowan Jose L Dominguez-Escrig Paolo Gontero A Hugh Mostafid Joan Palou Benoit Peyronnet Thomas Seisen Viktor Soukup Richard J Sylvester Bas WG van Rhijn Richard Zigeuner Shahrokh F Shariat |
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| Institution: | 1. Urology, GRC n°5, Predictive ONCO-URO, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France;2. Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Prague, Czech Republic;3. Department of Urology, Medical University of Vienna, Vienna, Austria;4. Department of Urology, Caritas-St. Josef Medical Center, University of Regensburg, Regensburg, Germany;5. Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic;6. Urology, Royal Free London-NHS Foundation Trust, Royal Free Hospital, London, UK;7. Department of Pathology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Hopital Tenon, Paris, France;8. Department of Radiology, The Queen Alexandra Hospital, Portsmouth, UK;9. Urology, Fundación Instituto Valenciano de Oncología (I.V.O.), Valencia, Spain;10. Division of Urology, Molinette Hospital, University of Torino School of Medicine, Torino, Italy;11. Royal Surrey Hospital, Guildford, UK;12. Department of Urology, Fundacio Puigvert, Universidad Autonoma de Barcelona, Barcelona, Spain;13. Department of urology, university of Rennes, Rennes, France;14. EAU Guidelines Office, Arnhem, The Netherlands;15. Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;p. Department of Urology, Medical University of Graz, Graz, Austria;q. Department of Urology Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria;r. Department of Urology, Weill Cornell Medical College, New York, NY, USA;s. Department of Urology, University of Texas Southwestern, Dallas, TX, USA;t. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia |
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| Abstract: | ContextThe European Association of Urology (EAU) Guidelines Panel on Upper Urinary Tract Urothelial Carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the current evidence-based management of UTUC and to incorporate recommendations into clinical practice.ObjectiveTo provide an overview of the EAU guidelines on UTUC as an aid to clinicians.Evidence acquisitionThe recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified following a systematic search of Medline. Data on urothelial malignancies and UTUC were searched using the following keywords: urinary tract cancer, urothelial carcinomas, upper urinary tract carcinoma, renal pelvis, ureter, bladder cancer, chemotherapy, ureteroscopy, nephroureterectomy, neoplasm, adjuvant treatment, instillation, recurrence, risk factors, and survival. References were weighted by a panel of experts.Evidence synthesisOwing to the rarity of UTUC, there are insufficient data to provide strong recommendations. The 2017 tumour, node, metastasis (TNM) classification is recommended. Recommendations are given for diagnosis and risk stratification as well as for radical and conservative treatment, and prognostic factors are discussed. A single postoperative dose of intravesical mitomycin after nephroureterectomy reduces the risk of bladder tumour recurrence. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk tumour and two functional kidneys. After radical nephroureterectomy, cisplatin-based chemotherapy is indicated in locally advanced UTUC.ConclusionsThese guidelines contain information on the management of individual patients according to a current standardised approach. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen, based on the proposed risk stratification of these tumours.Patient summaryUrothelial carcinoma of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, an appropriate diagnosis is most important. A number of known risk factors exist. |
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| Keywords: | Urothelial carcinoma Upper tract Neoplasm Risk factors Ureter Renal pelvis Diagnosis Cytology Ureteroscopy Management Nephroureterectomy Chemotherapy Systemic treatment Follow-up Survival Guidelines |
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