Upper Urinary Tract Disease: What We Know Today and Unmet Needs

Overview

Journal Transl Androl Urol

Date 2016 Jan 28

PMID 26816829

Citations 18

Authors

Romain Mathieu

Karim Bensalah

Ilaria Lucca

Aurelie Mbeutcha

Morgan Roupret

Shahrokh F Shariat

Affiliations

Soon will be listed here.

Abstract

Purpose: Upper tract urothelial carcinoma (UTUC) is a rare and poorly investigated disease. Intense collaborative efforts have increased our knowledge and improved the management of the disease. The objective of this review was to discuss recent advances and unmet needs in UTUC.

Methods: A non-systematic Medline/PubMed literature search was performed on UTUC using the terms "upper tract urothelial carcinoma" with different combinations of keywords. Original articles, reviews and editorials in English language were selected based on their clinical relevance.

Results: UTUC is a disease with specific epidemiologic and risk factors different to urothelial carcinoma of the bladder (UCB). Similarly to UCB, smoking increases the risk of UTUC and worsens its prognosis, whereas aristolochic acid (AA) exposure and mismatch repair genes abnormality are UTUC specific risk factors. A growing understanding of biological pathways involved in the tumorigenesis of UTUC has led to the identification of promising prognostic/predictive biomarkers. Risk stratification of UTUC is difficult due to limitations in staging and grading. Modern imaging and endoscopy have improved clinical decision-making, and allowed kidney-sparing management and surveillance in favorable-risk tumors. In high-risk tumors, radical nephroureterectomy (RNU) remains the standard. Complete removal of the intramural ureter is necessary with inferiority of endoscopic management. Post-RNU intravesical instillation has been shown to decrease bladder cancer recurrence rates. While the role of neoadjuvant cisplatin based combination chemotherapy and lymphadenectomy are not clearly established, the body of evidence suggests a survival benefit to these. There is currently no evidence for adjuvant chemotherapy (AC) in UTUC.

Conclusions: Despite growing interest and understanding of UTUC, its management remains challenging, requiring further high quality multicenter collaborations. Accurate risk estimation is necessary to avoid unnecessary RNUs while advances in technology are still required for optimal kidney-sparing approaches.

Citing Articles

Clinical Implication of Preoperative Renal Function on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy.

Kim T, Sung H, Oh J, Kang S, Seo H, Hong B Biomedicines. 2022; 10(6).

PMID: 35740362 PMC: 9220201. DOI: 10.3390/biomedicines10061340.

Diagnostic challenges and treatment strategies in the management of upper-tract urothelial carcinoma.

Schuettfort V, Pradere B, Quhal F, Mostafaei H, Laukhtina E, Mori K Turk J Urol. 2020; 47(Supp. 1):S33-S44.

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Comparative effectiveness of neoadjuvant chemotherapy in bladder and upper urinary tract urothelial carcinoma.

DAndrea D, Matin S, Black P, Petros F, Zargar H, Dinney C BJU Int. 2020; 127(5):528-537.

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Endoscopic Ultrasound-guided Fine Needle Aspiration for the Diagnosis of Duodenal Stenosis Due to Urothelial Carcinoma.

Motoo I, Ando T, Mihara H, Tanaka S, Nanjo S, Kajiura S Intern Med. 2020; 60(5):719-724.

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Imaging protocols for renal multiparametric MRI and MR urography: results of a consensus conference from the French Society of Genitourinary Imaging.

Rouviere O, Cornelis F, Brunelle S, Roy C, Andre M, Bellin M Eur Radiol. 2020; 30(4):2103-2114.

PMID: 31900706 DOI: 10.1007/s00330-019-06530-z.

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