Skip to main content

Advertisement

SpringerLink
Log in

Predictive tools for clinical decision-making and counseling of patients with upper tract urothelial carcinoma

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Background

Upper tract urothelial carcinoma (UTUC) is a rare disease with a highly heterogeneous biologic behavior. Accurate individualized prediction of the behavior of UTUC could help guide personalized clinical decision-making regarding optimal therapy.

Methods

A MEDLINE literature search was performed on UTUC predictive tools. We recorded input variables, prediction form, number of patients used to develop the prediction tools, outcomes being predicted, prediction tool-specific features, predictive accuracy, and whether internal or external validations were performed. Each prediction tool was classified according to the clinical disease state it addressed and the outcome it predicted.

Results

The literature search generated five published tools for UTUC staging and prognostication. None of these prediction tools have undergone external validation yet. Two tools focused on the clinical decision-making regarding conservative management versus radical nephroureterectomy (RNU), lymphadenectomy versus not, and neoadjuvant systemic therapy versus not. Three tools focused on the prognosis after RNU, thereby helping in the decision-making regarding adjuvant systemic chemotherapy.

Conclusions

Management of UTUC is challenging, and there are no high-level data to guide physicians and patients. Prognostic tools relying on data from large cohorts of patients are currently the best source of information for evidence-based management of UTUC patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Roupret M, Zigeuner R, Palou J, Boehle A, Kaasinen E, Sylvester R, Babjuk M, Oosterlinck W (2011) European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. Eur Urol 59:584–594

    Article  PubMed  Google Scholar 

  2. Ehdaie B, Chromecki TF, Lee RK, Lotan Y, Margulis V, Karakiewicz PI, Novara G, Raman JD, Ng C, Lowrance WT et al (2011) Obesity adversely impacts disease specific outcomes in patients with upper tract urothelial carcinoma. J Urol 186:66–72

    Article  PubMed  Google Scholar 

  3. Fajkovic H, Cha EK, Jeldres C, Donner G, Chromecki TF, Margulis V, Novara G, Lotan Y, Raman JD, Kassouf W et al (2012) Prognostic value of extranodal extension and other lymph node parameters in patients with upper tract urothelial carcinoma. J Urol 187:845–851

    Article  PubMed  Google Scholar 

  4. Kikuchi E, Margulis V, Karakiewicz PI, Roscigno M, Mikami S, Lotan Y, Remzi M, Bolenz C, Langner C, Weizer A et al (2009) Lymphovascular invasion predicts clinical outcomes in patients with node-negative upper tract urothelial carcinoma. J Clin Oncol 27:612–618

    Article  PubMed  Google Scholar 

  5. Raman JD, Ng CK, Scherr DS, Margulis V, Lotan Y, Bensalah K, Patard JJ, Kikuchi E, Montorsi F, Zigeuner R et al (2010) Impact of tumor location on prognosis for patients with upper tract urothelial carcinoma managed by radical nephroureterectomy. Eur Urol 57:1072–1079

    Article  PubMed  Google Scholar 

  6. Shariat SF, Favaretto RL, Gupta A, Fritsche HM, Matsumoto K, Kassouf W, Walton TJ, Tritschler S, Baba S, Matsushita K et al (2011) Gender differences in radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol 29:481–486

    Article  PubMed  Google Scholar 

  7. Lughezzani G, Burger M, Margulis V, Matin SF, Novara G, Roupret M, Shariat SF, Wood CG, Zigeuner R (2012) Prognostic factors in upper urinary tract urothelial carcinomas: a comprehensive review of the current literature. Eur Urol 62:100–114

    Article  PubMed  Google Scholar 

  8. Ouzzane A, Colin P, Xylinas E, Pignot G, Ariane MM, Saint F, Hoarau N, Adam E, Azemar MD, Bensadoun H et al (2011) Ureteral and multifocal tumours have worse prognosis than renal pelvic tumours in urothelial carcinoma of the upper urinary tract treated by nephroureterectomy. Eur Urol 60:1258–1265

    Article  PubMed  Google Scholar 

  9. Xylinas E, Rink M, Cha EK, Clozel T, Lee RK, Fajkovic H, Comploj E, Novara G, Margulis V, Raman JD et al. (2012) Impact of Distal Ureter Management on Oncologic Outcomes Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Eur Urol [Epub ahead of print]

  10. Shariat SF, Kattan MW, Vickers AJ, Karakiewicz PI, Scardino PT (2009) Critical review of prostate cancer predictive tools. Future Oncol 5:1555–1584

    Article  PubMed  Google Scholar 

  11. Kattan MW (2002) Nomograms Introduction. Semin Urol Oncol 20(2):79–81

    PubMed  Google Scholar 

  12. Kattan MW (2003) Comparison of Cox regression with other methods for determining prediction models and nomograms. J Urol 170:S6–S9

    Article  PubMed  Google Scholar 

  13. Kattan MW (2003) Nomograms are superior to staging and risk grouping systems for identifying high-risk patients: preoperative application in prostate cancer. Curr Opin Urol 13:111–116

    Article  PubMed  Google Scholar 

  14. Shariat SF, Capitanio U, Jeldres C, Karakiewicz PI (2009) Can nomograms be superior to other prediction tools? BJU Int 103:492–495

    Article  PubMed  Google Scholar 

  15. Shariat SF, Karakiewicz PI, Palapattu GS, Amiel GE, Lotan Y, Rogers CG, Vazina A, Bastian PJ, Gupta A, Sagalowsky AI et al (2006) Nomograms provide improved accuracy for predicting survival after radical cystectomy. Clin Cancer Res 12:6663–6676

    Article  PubMed  Google Scholar 

  16. Favaretto RL, Shariat SF, Savage C, Godoy G, Chade DC, Kaag M, Bochner BH, Coleman J, Dalbagni G (2012) Combining imaging and ureteroscopy variables in a preoperative multivariable model for prediction of muscle-invasive and non-organ confined disease in patients with upper tract urothelial carcinoma. BJU Int 109:77–82

    Article  PubMed  Google Scholar 

  17. Roscigno M, Brausi M, Heidenreich A, Lotan Y, Margulis V, Shariat SF, Van Poppel H, Zigeuner R (2011) Lymphadenectomy at the time of nephroureterectomy for upper tract urothelial cancer. Eur Urol 60:776–783

    Article  PubMed  Google Scholar 

  18. Matin SF, Margulis V, Kamat A, Wood CG, Grossman HB, Brown GA, Dinney CP, Millikan R, Siefker-Radtke AO (2010) Incidence of downstaging and complete remission after neoadjuvant chemotherapy for high-risk upper tract transitional cell carcinoma. Cancer 116:3127–3134

    Article  PubMed  Google Scholar 

  19. Lane BR, Smith AK, Larson BT, Gong MC, Campbell SC, Raghavan D, Dreicer R, Hansel DE, Stephenson AJ (2010) Chronic kidney disease after nephroureterectomy for upper tract urothelial carcinoma and implications for the administration of perioperative chemotherapy. Cancer 116:2967–2973

    Article  PubMed  Google Scholar 

  20. Messer JC, Terrell JD, Herman MP, Ng CK, Scherr DS, Scoll B, Boorjian SA, Uzzo RG, Wille M, Eggener SE et al. (2011) Multi-institutional validation of the ability of preoperative hydronephrosis to predict advanced pathologic tumor stage in upper-tract urothelial carcinoma. Urol Oncol [Epub ahead of print]

  21. Margulis V, Youssef RF, Karakiewicz PI, Lotan Y, Wood CG, Zigeuner R, Kikuchi E, Weizer A, Raman JD, Remzi M et al (2010) Preoperative multivariable prognostic model for prediction of nonorgan confined urothelial carcinoma of the upper urinary tract. J Urol 184:453–458

    Article  PubMed  Google Scholar 

  22. Brien JC, Shariat SF, Herman MP, Ng CK, Scherr DS, Scoll B, Uzzo RG, Wille M, Eggener SE, Terrell JD et al (2010) Preoperative hydronephrosis, ureteroscopic biopsy grade and urinary cytology can improve prediction of advanced upper tract urothelial carcinoma. J Urol 184:69–73

    Article  PubMed  Google Scholar 

  23. Shariat SF, Chade DC, Karakiewicz PI, Ashfaq R, Isbarn H, Fradet Y, Bastian PJ, Nielsen ME, Capitanio U, Jeldres C et al (2010) Combination of multiple molecular markers can improve prognostication in patients with locally advanced and lymph node positive bladder cancer. J Urol 183:68–75

    Article  PubMed  Google Scholar 

  24. Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E, Lotan Y, Weizer A, Raman JD, Wood CG (2009) Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer 115:1224–1233

    Article  PubMed  Google Scholar 

  25. Roscigno M, Shariat SF, Margulis V, Karakiewicz P, Remzi M, Kikuchi E, Zigeuner R, Weizer A, Sagalowsky A, Bensalah K et al (2009) The extent of lymphadenectomy seems to be associated with better survival in patients with nonmetastatic upper-tract urothelial carcinoma: how many lymph nodes should be removed? Eur Urol 56:512–518

    Article  PubMed  Google Scholar 

  26. Jeldres C, Sun M, Lughezzani G, Isbarn H, Shariat SF, Widmer H, Graefen M, Montorsi F, Perrotte P, Karakiewicz PI (2010) Highly predictive survival nomogram after upper urinary tract urothelial carcinoma. Cancer 116:3774–3784

    Article  PubMed  Google Scholar 

  27. Yates DR, Hupertan V, Colin P, Ouzzane A, Descazeaud A, Long JA, Pignot G, Crouzet S, Rozet F, Neuzillet Y et al (2012) Cancer-specific survival after radical nephroureterectomy for upper urinary tract urothelial carcinoma: proposal and multi-institutional validation of a post-operative nomogram. Br J Cancer 106:1083–1088

    Article  PubMed  CAS  Google Scholar 

  28. Cha EK, Shariat SF, Kormaksson M, Novara G, Chromecki TF, Scherr DS, Lotan Y, Raman JD, Kassouf W, Zigeuner R et al (2012) Predicting clinical outcomes after radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol 61:818–825

    Article  PubMed  Google Scholar 

  29. Nuhn P, May M, Fritsche HM, Buchner A, Brookman-May S, Bolenz C, Moritz R, Herrmann E, Burger M, Hofner T et al (2012) External validation of disease-free survival at 2 or 3 years as a surrogate and new primary endpoint for patients undergoing radical cystectomy for urothelial carcinoma of the bladder. Eur J Surg Oncol 38:637–642

    Article  PubMed  CAS  Google Scholar 

  30. Vickers AJ, Cronin AM, Kattan MW, Gonen M, Scardino PT, Milowsky MI, Dalbagni G, Bochner BH (2009) Clinical benefits of a multivariate prediction model for bladder cancer: a decision analytic approach. Cancer 115:5460–5469

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY, 10065, USA

    Evanguelos Xylinas, Luis Kluth, Sibani Mangal, Morgan Roupret & Shahrokh F. Shariat

  2. Division of Medical Oncology, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY, 10065, USA

    Shahrokh F. Shariat

  3. Department of Urology Cochin Hospital, APHP, Paris Descartes University, Paris, France

    Evanguelos Xylinas

  4. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Luis Kluth

  5. Department of Urology of la Pitié-Salpêtrière, APHP, University Paris VI, Paris, France

    Morgan Roupret

  6. Department of Urology, University of Montreal Health Center, Montreal, Canada

    Pierre I. Karakiewicz

Authors
  1. Evanguelos Xylinas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luis Kluth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sibani Mangal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Morgan Roupret
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pierre I. Karakiewicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shahrokh F. Shariat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Evanguelos Xylinas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Xylinas, E., Kluth, L., Mangal, S. et al. Predictive tools for clinical decision-making and counseling of patients with upper tract urothelial carcinoma. World J Urol 31, 31–36 (2013). https://doi.org/10.1007/s00345-012-0947-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-012-0947-5

Keywords

Search

Navigation