Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper-tract urothelial carcinoma (UTUC)
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Upper-tract urothelial carcinoma (UTUC) is a relatively uncommon disease with limited available evidence on specific topics. The purpose of this article was to review the previous literature to summarize the current knowledge about UTUC epidemiology, diagnosis, preoperative evaluation and prognostic assessment.
Using MEDLINE, a non-systematic review was performed including articles between January 2000 and February 2016. English language original articles, reviews and editorials were selected based on their clinical relevance.
UTUC accounts for 5–10 % of all urothelial cancers, with an increasing incidence. UTUC and bladder cancer share some common risk factors, even if they are two different entities regarding practical, biological and clinical characteristics. Aristolochic acid plays an important role in UTUC pathogenesis in certain regions. It is further estimated that approximately 10 % of UTUC are part of the hereditary non-polyposis colorectal cancer spectrum disease. UTUC diagnosis remains mainly based on imaging and endoscopy, but development of new technologies is rapidly changing the diagnosis algorithm. To help the decision-making process regarding surgical treatment, extent of lymphadenectomy and selection of neoadjuvant systemic therapies, predictive tools based on preoperative patient and tumor characteristics have been developed.
Awareness regarding epidemiology, diagnosis, preoperative evaluation and prognostic assessment changes is essential to correctly diagnose and manage UTUC patients, thereby potentially improving their outcomes.
KeywordsUTUC Epidemiology Risk factor Diagnosis New technologies Predictive tools Prognosis
Thalmann GN and Shariat SF were involved in protocol/project development; Soria F, Shariat SF, Lerner SP, Fritsche H, Rink M, Kassouf W, Spiess PE, Lotan Y, Ye D, Fernández MI, Kikuchi E, Chade DC, Babjuk M, Grollman AP and Thalmann GN were involved in data collection or management; Soria F, Shariat SF, Thalmann GN, Data analysis; Soria F, Shariat SF and Thalmann GN wrote the manuscript; Soria F, Shariat SF, Lerner SP, Fritsche H, Rink M, Kassouf W, Spiess PE, Lotan Y, Ye D, Fernández MI, Kikuchi E, Chade DC, Babjuk M, Grollman AP and Thalmann GN wrote and edited the manuscript.
Compliance with ethical standards
Conflict of interest
I certify that all conflicts of interest including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript are the following: Shahrokh Shariat owns or co-owns the following patents: Methods to determine prognosis after therapy for prostate cancer. Granted 2002-09-06. Methods to determine prognosis after therapy for bladder cancer. Granted 2003-06-19. Prognostic methods for patients with prostatic disease. Granted 2004-08-05. Soluble Fas: urinary marker for the detection of bladder transitional cell carcinoma. Granted 2010-07-20. He is advisory board member of Astellas, Cepheid, Ipsen, Jansen, Lilly, Olympus, Pfizer, Pierre Fabre, Sanofi, Wolff. He is speaker for Astellas, Ipsen, Jansen, Lilly, Olympus, Pfizer, Pierre Fabre, Sanochemia, Sanofi, Wolff.
This study was conducted according to the Declaration of Helsinki.
- 7.Favaretto RL, Shariat SF, Chade DC, Godoy G, Adamy A, Kaag M et al (2010) The effect of tumor location on prognosis in patients treated with radical nephroureterectomy at Memorial Sloan-Kettering Cancer Center. Eur Urol 58:574–580. doi: 10.1016/j.eururo.2010.07.003 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Otto W, Shariat SF, Fritsche H-M, Gupta A, Matsumoto K, Kassouf W et al (2011) Concomitant carcinoma in situ as an independent prognostic parameter for recurrence and survival in upper tract urothelial carcinoma: a multicenter analysis of 772 patients. World J Urol 29:487–494. doi: 10.1007/s00345-011-0645-8 CrossRefPubMedGoogle Scholar
- 18.Rouprêt M, Yates DR, Comperat E, Cussenot O (2008) Upper urinary tract urothelial cell carcinomas and other urological malignancies involved in the hereditary nonpolyposis colorectal cancer (lynch syndrome) tumor spectrum. Eur Urol 54:1226–1236. doi: 10.1016/j.eururo.2008.08.008 CrossRefPubMedGoogle Scholar
- 21.Rouprêt M, Drouin SJ, Cancel-Tassin G, Comperat E, Larré S, Cussenot O (2012) Genetic variability in 8q24 confers susceptibility to urothelial carcinoma of the upper urinary tract and is linked with patterns of disease aggressiveness at diagnosis. J Urol 187:424–428. doi: 10.1016/j.juro.2011.10.038 CrossRefPubMedGoogle Scholar
- 23.Raman JD, Shariat SF, Karakiewicz PI, Lotan Y, Sagalowsky AI, Roscigno M et al (2011) Does preoperative symptom classification impact prognosis in patients with clinically localized upper-tract urothelial carcinoma managed by radical nephroureterectomy? Urol Oncol 29:716–723. doi: 10.1016/j.urolonc.2009.11.007 CrossRefPubMedGoogle Scholar
- 26.Williams SK, Denton KJ, Minervini A, Oxley J, Khastigir J, Timoney AG et al (2008) Correlation of upper-tract cytology, retrograde pyelography, ureteroscopic appearance, and ureteroscopic biopsy with histologic examination of upper-tract transitional cell carcinoma. J Endourol 22:71–76. doi: 10.1089/end.2007.9853 CrossRefPubMedGoogle Scholar
- 30.Chlapoutakis K, Theocharopoulos N, Yarmenitis S, Damilakis J (2010) Performance of computed tomographic urography in diagnosis of upper urinary tract urothelial carcinoma, in patients presenting with hematuria: systematic review and meta-analysis. Eur J Radiol 73:334–338. doi: 10.1016/j.ejrad.2008.10.026 CrossRefPubMedGoogle Scholar
- 33.Takahashi N, Kawashima A, Glockner JF, Hartman RP, Leibovich BC, Brau ACS et al (2008) Small (<2-cm) upper-tract urothelial carcinoma: evaluation with gadolinium-enhanced three-dimensional spoiled gradient-recalled echo MR urography 1. Radiology 247:451–457. doi: 10.1148/radiol.2472070798 CrossRefPubMedGoogle Scholar
- 34.Tanaka H, Yoshida S, Komai Y, Sakai Y, Urakami S, Yuasa T et al (2016) Clinical value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in upper tract urothelial carcinoma: impact on detection of metastases and patient management. Urol Int 96:65–72. doi: 10.1159/000381269 CrossRefPubMedGoogle Scholar
- 36.Clements T, Messer JC, Terrell JD, Herman MP, Ng CK, Scherr DS et al (2012) High-grade ureteroscopic biopsy is associated with advanced pathology of upper-tract urothelial carcinoma tumors at definitive surgical resection. J Endourol 26:398–402. doi: 10.1089/end.2011.0426 CrossRefPubMedGoogle Scholar
- 40.Sung HH, Jeon HG, Han DH, Jeong BC, Il Seo S, Lee HM et al (2015) Diagnostic ureterorenoscopy is associated with increased intravesical recurrence following radical nephroureterectomy in upper tract urothelial carcinoma. PLoS ONE 10:e0139976. doi: 10.1371/journal.pone.0139976 CrossRefPubMedPubMedCentralGoogle Scholar
- 42.Nison L, Rouprêt M, Bozzini G, Ouzzane A, Audenet F, Pignot G et al (2013) The oncologic impact of a delay between diagnosis and radical nephroureterectomy due to diagnostic ureteroscopy in upper urinary tract urothelial carcinomas: results from a large collaborative database. World J Urol 31:69–76. doi: 10.1007/s00345-012-0959-1 CrossRefPubMedGoogle Scholar
- 51.Messer JC, Terrell JD, Herman MP, Ng CK, Scherr DS, Scoll B et al (2013) Multi-institutional validation of the ability of preoperative hydronephrosis to predict advanced pathologic tumor stage in upper-tract urothelial carcinoma. Urol Oncol 31:904–908. doi: 10.1016/j.urolonc.2011.07.011 CrossRefPubMedGoogle Scholar
- 52.Chung PH, Krabbe L-M, Darwish OM, Westerman ME, Bagrodia A, Gayed BA et al (2014) Degree of hydronephrosis predicts adverse pathological features and worse oncologic outcomes in patients with high-grade urothelial carcinoma of the upper urinary tract. Urol Oncol 32:981–988. doi: 10.1016/j.urolonc.2014.02.018 CrossRefPubMedGoogle Scholar
- 53.Isbarn H, Jeldres C, Shariat SF, Liberman D, Sun M, Lughezzani G et al (2009) Location of the primary tumor is not an independent predictor of cancer specific mortality in patients with upper urinary tract urothelial carcinoma. J Urol 182:2177–2181. doi: 10.1016/j.juro.2009.07.035 CrossRefPubMedGoogle Scholar
- 56.Remzi M, Haitel A, Margulis V, Karakiewicz P, Karakiewizc P, Montorsi F et al (2009) Tumour architecture is an independent predictor of outcomes after nephroureterectomy: a multi-institutional analysis of 1363 patients. BJU Int 103:307–311. doi: 10.1111/j.1464-410X.2008.08003.x CrossRefPubMedGoogle Scholar
- 58.Favaretto RL, Shariat SF, Savage C, Godoy G, Chade DC, Kaag M et al (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. doi: 10.1111/j.1464-410X.2011.10288.x CrossRefPubMedGoogle Scholar