European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2023 Update
The European Association of Urology (EAU) guidelines panel on upper urinary tract urothelial carcinoma (UTUC) has updated the guidelines to aid clinicians in evidence-based management of UTUC. To provide an overview of the EAU guidelines on UTUC as an aid to clinicians. The recommendations provided...
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| Vydáno v: | European urology Ročník 84; číslo 1; s. 49 - 64 |
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| Hlavní autoři: | , , , , , , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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Switzerland
Elsevier B.V
01.07.2023
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| Témata: | |
| ISSN: | 0302-2838, 1873-7560, 1421-993X, 1873-7560 |
| On-line přístup: | Získat plný text |
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| Abstract | The European Association of Urology (EAU) guidelines panel on upper urinary tract urothelial carcinoma (UTUC) has updated the guidelines to aid clinicians in evidence-based management of UTUC.
To provide an overview of the EAU guidelines on UTUC as an aid to clinicians.
The recommendations provided in these guidelines are based on a review of the literature via a systematic search of the PubMed, Ovid, EMBASE, and Cochrane databases. Data were searched using the following keywords: urinary tract cancer, urothelial carcinomas, renal pelvis, ureter, bladder cancer, chemotherapy, ureteroscopy, nephroureterectomy, neoplasm, (neo)adjuvant treatment, instillation, recurrence, risk factors, metastatic, immunotherapy, and survival. The results were assessed by a panel of experts.
Even though data are accruing, for many areas there is still insufficient high-level evidence to provide strong recommendations. Patient stratification on the basis of histology and clinical examination (including imaging) and assessment of patients at risk of Lynch syndrome will aid management. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk UTUC and two functional kidneys. In particular, for patients with high-risk or metastatic UTUC, new treatment options have become available. In high-risk UTUC, platinum-based chemotherapy after radical nephroureterectomy, and adjuvant nivolumab for unfit or patients who decline chemotherapy, are options. For metastatic disease, gemcitabine/carboplatin chemotherapy is recommended as first-line treatment for cisplatin-ineligible patients. Patients with PD-1/PD-L1–positive tumours should be offered a checkpoint inhibitor (pembrolizumab or atezolizumab).
These guidelines contain information on the management of individual patients according to the current best evidence. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen according to the risk stratification of these tumours.
Cancer of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, timely and appropriate diagnosis is most important. A number of known risk factors exist. |
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| AbstractList | The European Association of Urology (EAU) guidelines panel on upper urinary tract urothelial carcinoma (UTUC) has updated the guidelines to aid clinicians in evidence-based management of UTUC.
To provide an overview of the EAU guidelines on UTUC as an aid to clinicians.
The recommendations provided in these guidelines are based on a review of the literature via a systematic search of the PubMed, Ovid, EMBASE, and Cochrane databases. Data were searched using the following keywords: urinary tract cancer, urothelial carcinomas, renal pelvis, ureter, bladder cancer, chemotherapy, ureteroscopy, nephroureterectomy, neoplasm, (neo)adjuvant treatment, instillation, recurrence, risk factors, metastatic, immunotherapy, and survival. The results were assessed by a panel of experts.
Even though data are accruing, for many areas there is still insufficient high-level evidence to provide strong recommendations. Patient stratification on the basis of histology and clinical examination (including imaging) and assessment of patients at risk of Lynch syndrome will aid management. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk UTUC and two functional kidneys. In particular, for patients with high-risk or metastatic UTUC, new treatment options have become available. In high-risk UTUC, platinum-based chemotherapy after radical nephroureterectomy, and adjuvant nivolumab for unfit or patients who decline chemotherapy, are options. For metastatic disease, gemcitabine/carboplatin chemotherapy is recommended as first-line treatment for cisplatin-ineligible patients. Patients with PD-1/PD-L1–positive tumours should be offered a checkpoint inhibitor (pembrolizumab or atezolizumab).
These guidelines contain information on the management of individual patients according to the current best evidence. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen according to the risk stratification of these tumours.
Cancer of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, timely and appropriate diagnosis is most important. A number of known risk factors exist. The European Association of Urology (EAU) guidelines panel on upper urinary tract urothelial carcinoma (UTUC) has updated the guidelines to aid clinicians in evidence-based management of UTUC.CONTEXTThe European Association of Urology (EAU) guidelines panel on upper urinary tract urothelial carcinoma (UTUC) has updated the guidelines to aid clinicians in evidence-based management of UTUC.To provide an overview of the EAU guidelines on UTUC as an aid to clinicians.OBJECTIVETo provide an overview of the EAU guidelines on UTUC as an aid to clinicians.The recommendations provided in these guidelines are based on a review of the literature via a systematic search of the PubMed, Ovid, EMBASE, and Cochrane databases. Data were searched using the following keywords: urinary tract cancer, urothelial carcinomas, renal pelvis, ureter, bladder cancer, chemotherapy, ureteroscopy, nephroureterectomy, neoplasm, (neo)adjuvant treatment, instillation, recurrence, risk factors, metastatic, immunotherapy, and survival. The results were assessed by a panel of experts.EVIDENCE ACQUISITIONThe recommendations provided in these guidelines are based on a review of the literature via a systematic search of the PubMed, Ovid, EMBASE, and Cochrane databases. Data were searched using the following keywords: urinary tract cancer, urothelial carcinomas, renal pelvis, ureter, bladder cancer, chemotherapy, ureteroscopy, nephroureterectomy, neoplasm, (neo)adjuvant treatment, instillation, recurrence, risk factors, metastatic, immunotherapy, and survival. The results were assessed by a panel of experts.Even though data are accruing, for many areas there is still insufficient high-level evidence to provide strong recommendations. Patient stratification on the basis of histology and clinical examination (including imaging) and assessment of patients at risk of Lynch syndrome will aid management. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk UTUC and two functional kidneys. In particular, for patients with high-risk or metastatic UTUC, new treatment options have become available. In high-risk UTUC, platinum-based chemotherapy after radical nephroureterectomy, and adjuvant nivolumab for unfit or patients who decline chemotherapy, are options. For metastatic disease, gemcitabine/carboplatin chemotherapy is recommended as first-line treatment for cisplatin-ineligible patients. Patients with PD-1/PD-L1-positive tumours should be offered a checkpoint inhibitor (pembrolizumab or atezolizumab).EVIDENCE SYNTHESISEven though data are accruing, for many areas there is still insufficient high-level evidence to provide strong recommendations. Patient stratification on the basis of histology and clinical examination (including imaging) and assessment of patients at risk of Lynch syndrome will aid management. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk UTUC and two functional kidneys. In particular, for patients with high-risk or metastatic UTUC, new treatment options have become available. In high-risk UTUC, platinum-based chemotherapy after radical nephroureterectomy, and adjuvant nivolumab for unfit or patients who decline chemotherapy, are options. For metastatic disease, gemcitabine/carboplatin chemotherapy is recommended as first-line treatment for cisplatin-ineligible patients. Patients with PD-1/PD-L1-positive tumours should be offered a checkpoint inhibitor (pembrolizumab or atezolizumab).These guidelines contain information on the management of individual patients according to the current best evidence. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen according to the risk stratification of these tumours.CONCLUSIONSThese guidelines contain information on the management of individual patients according to the current best evidence. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen according to the risk stratification of these tumours.Cancer of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, timely and appropriate diagnosis is most important. A number of known risk factors exist.PATIENT SUMMARYCancer of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, timely and appropriate diagnosis is most important. A number of known risk factors exist. Context: The European Association of Urology (EAU) guidelines panel on upper urinary tract urothelial carcinoma (UTUC) has updated the guidelines to aid clinicians in evidence-based management of UTUC. Objective: To provide an overview of the EAU guidelines on UTUC as an aid to clinicians. Evidence acquisition: The recommendations provided in these guidelines are based on a review of the literature via a systematic search of the PubMed, Ovid, EMBASE, and Cochrane databases. Data were searched using the following keywords: urinary tract cancer, urothelial carcinomas, renal pelvis, ureter, bladder cancer, chemotherapy, ureteroscopy, nephroureterectomy, neoplasm, (neo)adjuvant treatment, instillation, recurrence, risk factors, metastatic, immunotherapy, and survival. The results were assessed by a panel of experts. Evidence synthesis: Even though data are accruing, for many areas there is still insufficient high-level evidence to provide strong recommendations. Patient stratification on the basis of histology and clinical examination (including imaging) and assessment of patients at risk of Lynch syndrome will aid management. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk UTUC and two functional kidneys. In particular, for patients with high-risk or metastatic UTUC, new treatment options have become available. In high-risk UTUC, platinum-based chemotherapy after radical nephroureterectomy, and adjuvant nivolumab for unfit or patients who decline chemotherapy, are options. For metastatic disease, gemcitabine/carboplatin chemotherapy is recommended as first-line treatment for cisplatin-ineligible patients. Patients with PD-1/PD-L1–positive tumours should be offered a checkpoint inhibitor (pembrolizumab or atezolizumab). Conclusions: These guidelines contain information on the management of individual patients according to the current best evidence. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen according to the risk stratification of these tumours. Patient summary: Cancer of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, timely and appropriate diagnosis is most important. A number of known risk factors exist. |
| Author | Mariappan, Paramananthan Rai, Bhavan P. van Rhijn, Bas W.G. Compérat, Eva M. Rouprêt, Morgan Seisen, Thomas Dominguez-Escrig, José L. Hugh Mostafid, A. Soria, Francesco Capoun, Otakar Xylinas, Evanguelos N. Wood, Robbert G. Soukup, Viktor Pradere, Benjamin Masson-Lecomte, Alexandra Gontero, Paolo Gürses Andersson, Irene Shariat, Shahrokh F. Birtle, Alison J. Liedberg, Fredrik |
| Author_xml | – sequence: 1 givenname: Morgan surname: Rouprêt fullname: Rouprêt, Morgan email: morgan.roupret@aphp.fr organization: GRC 5 Predictive Onco-Uro, Sorbonne University, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France – sequence: 2 givenname: Thomas surname: Seisen fullname: Seisen, Thomas organization: GRC 5 Predictive Onco-Uro, Sorbonne University, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France – sequence: 3 givenname: Alison J. surname: Birtle fullname: Birtle, Alison J. organization: Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK – sequence: 4 givenname: Otakar surname: Capoun fullname: Capoun, Otakar organization: Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia – sequence: 5 givenname: Eva M. surname: Compérat fullname: Compérat, Eva M. organization: Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia – sequence: 6 givenname: José L. surname: Dominguez-Escrig fullname: Dominguez-Escrig, José L. organization: Department of Urology, Fundación Instituto Valenciano de Oncología, Valencia, Spain – sequence: 7 givenname: Irene surname: Gürses Andersson fullname: Gürses Andersson, Irene organization: Patient advocate, Bladder Cancer Norway, Norway – sequence: 8 givenname: Fredrik surname: Liedberg fullname: Liedberg, Fredrik organization: Department of Translational Medicine, Lund University, Malmö, Sweden – sequence: 9 givenname: Paramananthan surname: Mariappan fullname: Mariappan, Paramananthan organization: Department of Urology, Edinburgh Bladder Cancer Surgery, Western General Hospital, Edinburgh, UK – sequence: 10 givenname: A. surname: Hugh Mostafid fullname: Hugh Mostafid, A. organization: Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK – sequence: 11 givenname: Benjamin surname: Pradere fullname: Pradere, Benjamin organization: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria – sequence: 12 givenname: Bas W.G. surname: van Rhijn fullname: van Rhijn, Bas W.G. organization: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany – sequence: 13 givenname: Shahrokh F. surname: Shariat fullname: Shariat, Shahrokh F. organization: Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czechia – sequence: 14 givenname: Bhavan P. surname: Rai fullname: Rai, Bhavan P. organization: Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK – sequence: 15 givenname: Francesco surname: Soria fullname: Soria, Francesco organization: Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy – sequence: 16 givenname: Viktor surname: Soukup fullname: Soukup, Viktor organization: Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia – sequence: 17 givenname: Robbert G. surname: Wood fullname: Wood, Robbert G. organization: Patient advocate, Bladder Cancer Norway, Norway – sequence: 18 givenname: Evanguelos N. surname: Xylinas fullname: Xylinas, Evanguelos N. organization: Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université de Paris, Paris, France – sequence: 19 givenname: Alexandra surname: Masson-Lecomte fullname: Masson-Lecomte, Alexandra organization: Department of Urology, Université de Paris, AP-HP, Saint Louis Hospital, Paris, France – sequence: 20 givenname: Paolo surname: Gontero fullname: Gontero, Paolo organization: Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36967359$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | (Neo)adjuvant therapy Carcinoma, Transitional Cell - diagnosis Carcinoma, Transitional Cell - pathology Carcinoma, Transitional Cell - therapy Chemotherapy Clinical Medicine Genetic screening Humans Immunotherapy Kidney Neoplasms - diagnosis Kidney Neoplasms - pathology Kidney Neoplasms - therapy Kidney Pelvis - pathology Klinisk medicin Management Medical and Health Sciences Medicin och hälsovetenskap Prognostic factors Renal pelvis Surgery Ureter Ureteral Neoplasms - diagnosis Ureteral Neoplasms - pathology Ureteral Neoplasms - therapy Urinary Bladder Neoplasms - pathology Urology Urothelial carcinoma |
| Title | European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2023 Update |
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