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.
To provide a brief overview of the EAU guidelines on UTUC as an aid to clinicians in their daily clinical practice.
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.
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.
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.
Keywords: Urothelial carcinoma, Urinary tract cancer, Risk factors, Ureter, Renal pelvis, Cytology, Ureteroscopy, Radical nephroureterectomy, Survival, Recurrence, Guidelines.
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
© 2013 European Association of Urology, Published by Elsevier B.V.