GuidelinesEuropean Association of Urology Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma: 2015 Update
Introduction
The previous European Association of Urology (EAU) guidelines on upper urinary tract urothelial cell carcinoma (UTUC) were published in 2013 [1]. The EAU guidelines panel has prepared updated guidelines to provide evidence-based information on the management of these tumours in clinical practice.
Section snippets
Data identification
A Medline search was performed using combinations of the following terms: urinary tract cancer; urothelial carcinomas, upper urinary tract, urothelial carcinoma, renal pelvis, ureter, chemotherapy, nephroureterectomy, adjuvant treatment, neoadjuvant treatment, recurrence, risk factors, nomogram, and survival. The publications identified were mainly retrospective including some large multicentre studies. Due to the scarcity of randomised data, articles were selected based on the following
Epidemiology
Urothelial carcinomas (UCs) are the fourth most common tumours [1]. They can be located in the lower urinary tract (bladder and urethra) or the upper (pyelocaliceal cavities and ureter). Bladder tumours account for 90–95% of UCs and are the most common urinary tract malignancy [3]. However, UTUCs are uncommon and account for only 5–10% of UCs [1], [4], with an estimated annual incidence in Western countries of almost 2 cases per 100 000 inhabitants. Pyelocaliceal tumours are approximately twice
Classification
The classification and morphology of UTUC and bladder carcinoma are similar [1]. It is possible to distinguish between noninvasive papillary tumours (papillary urothelial tumours of low malignant potential and low-grade and high-grade papillary UC), flat lesions (carcinoma in situ [CIS]), and invasive carcinoma.
Tumour node metastasis staging
The TNM classification is shown in Table 1 [18]. The regional lymph nodes to be considered are the hilar, abdominal para-aortic, and paracaval nodes, and for the ureter, the intrapelvic
Symptoms
The diagnosis of UTUC may be fortuitous or related to the evaluation of symptoms that are generally limited [1]. The most common symptom is visible or nonvisible haematuria (70–80%) [1]. Flank pain occurs in 20–40% of cases, and a lumbar mass is present in 10–20% [22], [23]. Systemic symptoms (including anorexia, weight loss, malaise, fatigue, fever, night sweats, or cough) associated with UTUC should prompt more rigorous metastatic evaluation [22], [23].
Computed tomography urography
Computed tomography (CT) urography has
Prognostic factors
UTUCs that invade the muscle wall usually have a very poor prognosis. The 5-yr specific survival is <50% for pT2/pT3 and <10% for pT4 [1], [30]. The main prognostic factors are briefly listed here. Figure 2 shows an exhaustive list.
Kidney-sparing surgery
Conservative management of UTUC can be carried out in low-risk cases when the contralateral kidney is functional [1]. Kidney-sparing surgery for low-risk UTUC (Table 3) prevents the morbidity associated with open radical surgery without compromising oncologic outcome and kidney function [59]. In addition, it can also be considered in all serious cases (ie, renal insufficiency or solitary kidney) (LE: 3).
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2023, Actas Urologicas Espanolas