Articles

European Guidelines on Upper Tract Urothelial Carcinomas: 2013 Update

By: Morgan Rouprêta lowast , Marko Babjukb, Eva Compératc, Richard Zigeunerd, Richard Sylvestere, Max Burgerf, Nigel Cowang, Andreas Böhleh, Bas W.G. Van Rhijni, Eero Kaasinenj, Joan Palouk and Shahrokh F. Shariatl

Published online: 01 June 2013

Keywords: Urothelial carcinoma, Urinary tract cancer, Risk factors, Ureter, Renal pelvis, Cytology, Ureteroscopy, Radical nephroureterectomy, Survival, Recurrence, Guidelines

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Abstract

Context

The European Association of Urology (EAU) guideline group for upper tract urothelial carcinoma (UTUC) has prepared updated guidelines to aid clinicians in assessing the current evidence-based management of UTUC and to incorporate present recommendations into daily clinical practice.

Objective

To provide a brief overview of the EAU guidelines on UTUC as an aid to clinicians in their daily clinical practice.

Evidence acquisition

The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified using a systematic search of Medline. Data on urothelial malignancies and UTUCs in the literature were searched using Medline with the following keywords: urinary tract cancer; urothelial carcinomas; upper urinary tract, carcinoma; renal pelvis; ureter; bladder cancer; chemotherapy; nephroureterectomy; adjuvant treatment; instillation; neoadjuvant treatment; recurrence; risk factors; nomogram; and survival. References were weighted by a panel of experts.

Evidence synthesis

There is a lack of data in the current literature to provide strong recommendations (ie, grade A) due to the rarity of the disease. A number of recent multicentre studies are now available, and there is a growing interest in UTUC in the recent literature. Overall, 135 references have been included here, but most of these studies are still retrospective analyses. The TNM 2009 classification is recommended. Recommendations are given for diagnosis as well as radical and conservative treatment (ie, imperative and elective cases); additionally, prognostic factors are discussed. Recommendations are also provided for patient follow-up after different therapeutic options.

Conclusions

These guidelines contain information for the management of individual patients according to a current standardised approach. Physicians must take into account the specific clinical characteristics of each individual patient when determining the optimal treatment regimen including tumour location, grade, and stage; renal function; molecular marker status; and medical comorbidities.

Take Home Message

The European Association of Urology guidelines group for urothelial carcinoma of the upper tract (UTUC) has prepared updated guidelines. Recommendations are given for diagnosis, treatment, and follow-up to aid clinicians in their daily practice. Because of the rarity of UTUC, there is a lack of data, and most of the recommendations have a grade lower than A.

Keywords: Urothelial carcinoma, Urinary tract cancer, Risk factors, Ureter, Renal pelvis, Cytology, Ureteroscopy, Radical nephroureterectomy, Survival, Recurrence, Guidelines.

Footnotes

a Department of Urology, Groupe Hospitalier Pitié – Salpêtrière, Assistance Publique Hopitaux de Paris, Faculty of Medicine Pierre et Marie Curie, Institut Universitaire de Cancérologie GRC5, University Paris 6, Paris, France

b Department of Urology, Charles University, Prague, Czech Republic

c Department of Pathology, Groupe Hospitalier Pitié – Salpêtrière, Assistance Publique Hopitaux de Paris, Faculty of Medicine Pierre et Marie Curie, Institut Universitaire de Cancérologie GRC5, University Paris 6, Paris, France

d Department of Urology, Medizinische Universität Graz, Graz, Austria

e Department of Biostatistics, EORTC Headquarters, Brussels, Belgium

f Department of Urology and Paediatric Urology, Julius-Maximilians-University Würzburg, Würzburg, Germany

g Department of Radiology, The Manor Hospital, Oxford, UK

h Helios Agnes Karll Krankenhaus, Schwartau, Germany

i Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

j Department of Surgery, Hyvinkää Hospital, Hyvinkää, Finland

k Department of Urology, Universitat Autònoma de Barcelona - Fundació Puigvert, Barcelona, Spain

l Department of Urology, Weill Cornell University Medical Centre, New York, NY, USA

lowast Corresponding author. Groupe Hospitalier Pitié – Salpêtrière, Academic Department of Urology, 83 Bd de l’Hôpital, 75634 Paris, France. Tel. +33 1 44 17 71 39.