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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Bibliographic Details
Published in:European urology Vol. 84; no. 1; pp. 49 - 64
Main Authors: Rouprêt, Morgan, Seisen, Thomas, Birtle, Alison J., Capoun, Otakar, Compérat, Eva M., Dominguez-Escrig, José L., Gürses Andersson, Irene, Liedberg, Fredrik, Mariappan, Paramananthan, Hugh Mostafid, A., Pradere, Benjamin, van Rhijn, Bas W.G., Shariat, Shahrokh F., Rai, Bhavan P., Soria, Francesco, Soukup, Viktor, Wood, Robbert G., Xylinas, Evanguelos N., Masson-Lecomte, Alexandra, Gontero, Paolo
Format: Journal Article
Language:English
Published: Switzerland Elsevier B.V 01.07.2023
Subjects:
(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
Chemotherapy
(Neo)adjuvant therapy
Renal pelvis
Surgery
Immunotherapy
Ureter
Management
Urothelial carcinoma
Prognostic factors
Genetic screening
ISSN:0302-2838, 1873-7560, 1421-993X, 1873-7560
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Summary: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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content type line 23
ISSN:0302-2838
1873-7560
1421-993X
1873-7560
DOI:10.1016/j.eururo.2023.03.013