Consultation on UTUC, Stockholm 2018 aspects of risk stratification: long-term results and follow-up

Hasan, M. N., Rouprêt, M., Keeley, F., Cracco, C., Jones, R. , Straub, M., Traxer, O., Osther, P. J. S. and Brehmer, M. (2019) Consultation on UTUC, Stockholm 2018 aspects of risk stratification: long-term results and follow-up. World Journal of Urology, 37(11), pp. 2289-2296. (doi: 10.1007/s00345-019-02739-1) (PMID:30944969) (PMCID:PMC6825637)

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Abstract

Purpose: To summarize current knowledge on upper urinary tract carcinoma (UTUC) regarding risk stratification, long-term results, and follow-up. Methods: A scoping review approach was applied to search literature in Pubmed, Web of Science, and Embase. Consensus was reached through discussions at Consultation on UTUC, September 2018, Stockholm. Results: To optimize oncological outcome considering both cancer-specific survival (CSS) and overall survival (OS), it is essential to identify pre- and postoperative prognostic factors. In low-risk UTUC, kidney-sparing surgery (KSS) and radical nephroureterectomy (RNU) offer equivalent CSS, whereas RNU may result in poorer OS due to nephron loss. For more aggressive tumours, undergrading can lead to insufficient treatment. The strongest prognostic factors are tumour stage and grade. Determining grade is best achieved by ureterorenoscopy (URS) with focal samples, biopsy and cytology. Staging is more difficult but can be indirectly achieved by multiphase computed tomography urography (CTU) or tumour grade determined by cytology and histopathology. Patients treated with KSS should be monitored closely with regular follow-ups (URS and CTU). Conclusion: KSS should be offered in low-risk UTUC when feasible, whereas RNU is the treatment of choice in organ-confined high-risk UTUC. Intravesical recurrence (IVR) is common after RNU, but a single postoperative dose of mitomycin instillation decreases IVR. Endourological management has high local and bladder recurrence rates; however, its effect on CSS or overall survival OS is unclear. RNU is associated with significant risk of chronic kidney disease. Careful selection of patients and risk stratification are mandatory, and patients should be followed according to strict protocols.

Item Type:Articles
Keywords:Follow-up, KSS, prognosis, RNU, renal pelvis, risk stratification, treatment, UTUC, upper tract, ureter, urothelial carcinoma.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Jones, Professor Robert
Authors: Hasan, M. N., Rouprêt, M., Keeley, F., Cracco, C., Jones, R., Straub, M., Traxer, O., Osther, P. J. S., and Brehmer, M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
Journal Name:World Journal of Urology
Publisher:Springer
ISSN:0724-4983
ISSN (Online):1433-8726
Published Online:03 April 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in World Journal of Urology 37(11):2289-2296
Publisher Policy:Reproduced under a Creative Commons License

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