European Association of Urology Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma: 2015 Update
Abstract
Context: The European Association of Urology (EAU) guidelines panel on upper urinary tract urothelial cell carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the current evidence-based management of UTUC and to incorporate recommendations into clinical practice. Objective: To provide a brief overview of the EAU guidelines on UTUC as an aid to clinicians.
Evidence acquisition: The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified following a systematic search of Medline. Data on urothelial malignancies and UTUC were searched using these keywords: urinary tract cancer; urothelial carcinomas; upper urinary tract, carcinoma; renal pelvis; ureter; bladder cancer; chemotherapy; nephroureterectomy; adjuvant treatment; instillation; neoadjuvant treatment; recurrence; risk factors; and survival.
References were weighted by a panel of experts. Evidence synthesis: Due to the rarity of UTUC, there are insufficient data to provide strong recommendations (ie, grade A).
However, the results of recent multicentre studies are now available, and there is a growing interest in UTUC. The 2009 TNM classification is recommended.
Recommendations are given for diagnosis and risk stratification as well as radical and conservative treatment, and prognostic factors are discussed. A single postoperative dose of intravesical mitomycin after nephroureterectomy reduces the risk of bladder tumour recurrence.
Recommendations are also provided for patient follow-up after different therapeutic strategies. Conclusions: These guidelines contain information on the management of individual patients according to a current standardised approach.
Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen, based on the proposed risk stratification of these tumours.