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Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of low-risk upper tract urothelial carcinoma

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Abstract

Introduction

The conservative management of upper tract urothelial carcinoma (UTUC) has historically been offered to patients with imperative indications. The recent International Consultation on Urologic Diseases (ICUD) publication on UTUC stratified treatment allocations based on high- and low-risk groups. This report updates the conservative management of the low-risk group.

Methods

The ICUD for low-risk UTUC working group performed a thorough review of the literature with an assessment of the level of evidence and grade of recommendation for a variety of published studies in this disease space. We update these publications and provide a summary of that original report.

Results

There are no prospective randomized controlled studies to support surgical management guidelines. A risk-stratified approach based on clinical, endoscopic, and biopsy assessment allows selection of patients who could benefit from kidney-preserving procedures with oncological outcomes potentially similar to radical nephroureterectomy with bladder cuff excision, with the added benefit of renal function preservation. These treatments are aided by the development of high-definition flexible digital URS, multi-biopsies with the aid of access sheaths and other tools, and promising developments in the use of adjuvant topical therapy.

Conclusions

Recent developments in imaging, minimally invasive techniques, multimodality approaches, and adjuvant topical regimens and bladder cancer prevention raise the hope for improved risk stratification and may greatly improve the endoscopic treatment for low-risk UTUC.

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References

  1. Roupret M et al (2015) European Association of Urology guidelines on upper urinary tract urothelial cell carcinoma: 2015 update. Eur Urol 68(5):868–879

    Article  PubMed  Google Scholar 

  2. Andersen JR, Kristensen JK (1994) Ureteroscopic management of transitional cell tumors. Scand J Urol Nephrol 28(2):153–157

    Article  CAS  PubMed  Google Scholar 

  3. Roupret M et al (2013) European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol 63(6):1059–1071

    Article  PubMed  Google Scholar 

  4. Margulis V et al (2009) Outcomes of radical nephroureterectomy: a series from the upper tract urothelial carcinoma collaboration. Cancer 115(6):1224–1233

    Article  PubMed  Google Scholar 

  5. Fajkovic H et al (2013) Results and outcomes after endoscopic treatment of upper urinary tract carcinoma: the Austrian experience. World J Urol 31(1):37–44

    Article  PubMed  Google Scholar 

  6. Sverrisson EF et al (2014) The merits of cytology in the workup for upper tract urothelial carcinoma—a contemporary review of a perplexing issue. Int Braz J Urol 40(4):493–498

    Article  CAS  PubMed  Google Scholar 

  7. Roupret M, Colin P, Yates DR (2014) A new proposal to risk stratify urothelial carcinomas of the upper urinary tract (UTUCs) in a predefinitive treatment setting: low-risk versus high-risk UTUCs. Eur Urol 66(2):181–183

    Article  PubMed  Google Scholar 

  8. Yakoubi R et al (2014) Radical nephroureterectomy versus endoscopic procedures for the treatment of localised upper tract urothelial carcinoma: a meta-analysis and a systematic review of current evidence from comparative studies. Eur J Surg Oncol 40(12):1629–1634

    Article  CAS  PubMed  Google Scholar 

  9. Seisen T et al (2015) A systematic review and meta-analysis of clinicopathologic factors linked to intravesical recurrence after radical nephroureterectomy to treat upper tract urothelial carcinoma. Eur Urol 67(6):1122–1133

    Article  PubMed  Google Scholar 

  10. Cutress ML et al (2012) Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): systematic review. BJU Int 110(5):614–628

    Article  PubMed  Google Scholar 

  11. Thompson RH et al (2008) Elective endoscopic management of transitional cell carcinoma first diagnosed in the upper urinary tract. BJU Int 102(9):1107–1110

    Article  PubMed  Google Scholar 

  12. Takeuchi M et al (2015) CT urography for diagnosis of upper urinary tract urothelial carcinoma: are both nephrographic and excretory phases necessary? Am J Roentgenol (AJR) 205(3):W320–W327

    Article  Google Scholar 

  13. Potretzke AM et al. (2015) Is ureteroscopy needed prior to nephroureterectomy? An evidence-based algorithmic approach. Urology 88:43–48

    Article  PubMed  Google Scholar 

  14. Chlapoutakis K et al (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(2):334–338

    Article  PubMed  Google Scholar 

  15. Razavi SA et al (2012) Comparative effectiveness of imaging modalities for the diagnosis of upper and lower urinary tract malignancy: a critically appraised topic. Acad Radiol 19(9):1134–1140

    Article  PubMed  Google Scholar 

  16. Gillan A et al (2015) Carcinoma in situ is significantly underdetected by prenephroureterectomy ureteroscopy in the management of upper tract urothelial cancers. Biomed Res Int 2015:547586

    Article  PubMed  PubMed Central  Google Scholar 

  17. Vashistha V, Shabsigh A, Zynger DL (2013) Utility and diagnostic accuracy of ureteroscopic biopsy in upper tract urothelial carcinoma. Arch Pathol Lab Med 137(3):400–407

    Article  CAS  PubMed  Google Scholar 

  18. Wang J et al (2012) Distinguishing urothelial carcinoma in the upper urinary tract from benign diseases with hematuria using FISH. Acta Cytol 56(5):533–538

    Article  CAS  PubMed  Google Scholar 

  19. Smith AK et al (2011) Inadequacy of biopsy for diagnosis of upper tract urothelial carcinoma: implications for conservative management. Urology 78(1):82–86

    Article  PubMed  Google Scholar 

  20. Williams SK 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(1):71–76

    Article  PubMed  Google Scholar 

  21. Shiraishi K et al (2003) Role of ureteroscopic biopsy in the management of upper urinary tract malignancy. Int J Urol 10(12):627–630

    Article  PubMed  Google Scholar 

  22. Skolarikos A et al (2003) Cytologic analysis of ureteral washings is informative in patients with grade 2 upper tract TCC considering endoscopic treatment. Urology 61(6):1146–1150

    Article  CAS  PubMed  Google Scholar 

  23. Guarnizo E et al (2000) Ureteroscopic biopsy of upper tract urothelial carcinoma: improved diagnostic accuracy and histopathological considerations using a multi-biopsy approach. J Urol 163(1):52–55

    Article  CAS  PubMed  Google Scholar 

  24. Keeley FX et al (1997) Diagnostic accuracy of ureteroscopic biopsy in upper tract transitional cell carcinoma. J Urol 157(1):33–37

    Article  CAS  PubMed  Google Scholar 

  25. Tavora F et al (2009) Small endoscopic biopsies of the ureter and renal pelvis: pathologic pitfalls. Am J Surg Pathol 33(10):1540–1546

    Article  PubMed  Google Scholar 

  26. Renshaw AA (2006) Comparison of ureteral washing and biopsy specimens in the community setting. Cancer 108(1):45–48

    Article  PubMed  Google Scholar 

  27. Sedlock DJ, MacLennan GT (2004) Urine cytology in the evaluation of upper tract urothelial lesions. J Urol 172(6 Pt 1):2406

    Article  PubMed  Google Scholar 

  28. Messer J et al (2011) Urinary cytology has a poor performance for predicting invasive or high-grade upper-tract urothelial carcinoma. BJU Int 108(5):701–705

    PubMed  Google Scholar 

  29. Comploj E, Babjuk M, Capitanio U, Cha E, Colin P, Fritsche HM, Herrmann T, Hübner W, Klatte T, Merseburger A, Montorsi F, Pycha A, Roscigno M, Rouprêt M, Shariat S, Zigeuner R, Remzi M (2013) Role of conventional cytology in the treatment of upper tract urothelial carcinoma (OSS-UTUC): results from the multi-institutional organ-sparing-UTUC collaboration. Eur Urol Suppl 1(12):e601–e602

    Article  Google Scholar 

  30. Chen L et al (2015) Upper tract urinary cytology to detect upper tract urothelial carcinoma: using the Johns Hopkins Hospital template and evaluation of its feasibility. Cytojournal 12:17

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Tanaka N et al (2014) The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma: a multi-institutional study. Urol Oncol 32(1):48.e19–48.e26

    Article  Google Scholar 

  32. Wang L (2015) Diagnsosis of upper tract urothelial carcinoma-A comparative study of urine cytology and surgical biopsy. J Am Soc Cytopathol 4:3–9

    Article  CAS  Google Scholar 

  33. Daniely M et al (2007) Combined morphologic and fluorescence in situ hybridization analysis of voided urine samples for the detection and follow-up of bladder cancer in patients with benign urine cytology. Cancer 111(6):517–524

    Article  PubMed  Google Scholar 

  34. Reynolds JP et al (2014) Comparison of urine cytology and fluorescence in situ hybridization in upper urothelial tract samples. Cancer Cytopathol 122(6):459–467

    Article  PubMed  Google Scholar 

  35. Rai BP et al (2011) Surgical management for upper urinary tract transitional cell carcinoma. Cochrane Database Syst Rev (4):CD007349

  36. Kalaitzis C et al (2013) Ureteroscopic laser treatment of upper urinary tract urothelial cell carcinomas: can a tumour free status be achieved? Adv Urol 2013:429585

    Article  PubMed  PubMed Central  Google Scholar 

  37. Hoffman A et al (2014) Oncologic results of nephron sparing endoscopic approach for upper tract low grade transitional cell carcinoma in comparison to nephroureterectomy—a case control study. BMC Urol 14:97

    Article  PubMed  PubMed Central  Google Scholar 

  38. Cutress ML et al (2012) Long-term endoscopic management of upper tract urothelial carcinoma: 20-year single-centre experience. BJU Int 110(11):1608–1617

    Article  PubMed  Google Scholar 

  39. Grasso M et al (2012) Ureteroscopic and extirpative treatment of upper urinary tract urothelial carcinoma: a 15-year comprehensive review of 160 consecutive patients. BJU Int 110(11):1618–1626

    Article  PubMed  Google Scholar 

  40. Gadzinski AJ et al (2010) Long-term outcomes of nephroureterectomy versus endoscopic management for upper tract urothelial carcinoma. J Urol 183(6):2148–2153

    Article  PubMed  Google Scholar 

  41. Cornu JN et al (2010) Oncologic control obtained after exclusive flexible ureteroscopic management of upper urinary tract urothelial cell carcinoma. World J Urol 28(2):151–156

    Article  PubMed  Google Scholar 

  42. Pak RW, Moskowitz EJ, Bagley DH (2009) What is the cost of maintaining a kidney in upper-tract transitional-cell carcinoma? An objective analysis of cost and survival. J Endourol 23(3):341–346

    Article  PubMed  Google Scholar 

  43. Lucas SM et al (2008) Conservative management in selected patients with upper tract urothelial carcinoma compares favourably with early radical surgery. BJU Int 102(2):172–176

    Article  PubMed  Google Scholar 

  44. Painter DJ et al (2008) Ureteroscopic management of upper-tract urothelial cancer: an exciting nephron-sparing option or an unacceptable risk? J Endourol 22(6):1237–1239

    Article  PubMed  Google Scholar 

  45. Krambeck AE et al (2007) Endoscopic management of upper tract urothelial carcinoma in patients with a history of bladder urothelial carcinoma. J Urol 177(5):1721–1726

    Article  PubMed  Google Scholar 

  46. Reisiger K et al (2007) Office-based surveillance ureteroscopy after endoscopic treatment of transitional cell carcinoma: technique and clinical outcome. Urology 70(2):263–266

    Article  PubMed  Google Scholar 

  47. Roupret M et al (2006) Comparison of open nephroureterectomy and ureteroscopic and percutaneous management of upper urinary tract transitional cell carcinoma. Urology 67(6):1181–1187

    Article  PubMed  Google Scholar 

  48. Johnson GB, Grasso M (2005) Ureteroscopic management of upper urinary tract transitional cell carcinoma. Curr Opin Urol 15(2):89–93

    Article  PubMed  Google Scholar 

  49. Iborra I et al (2003) Conservative elective treatment of upper urinary tract tumors: a multivariate analysis of prognostic factors for recurrence and progression. J Urol 169(1):82–85

    Article  CAS  PubMed  Google Scholar 

  50. Matsuoka K et al (2003) Transurethral endoscopic treatment of upper urinary tract tumors using a holmium:YAG laser. Lasers Surg Med 32(5):336–340

    Article  PubMed  Google Scholar 

  51. Daneshmand S, Quek ML, Huffman JL (2003) Endoscopic management of upper urinary tract transitional cell carcinoma: long-term experience. Cancer 98(1):55–60

    Article  PubMed  Google Scholar 

  52. Chen GL, Bagley DH (2001) Ureteroscopic surgery for upper tract transitional-cell carcinoma: complications and management. J Endourol 15(4):399–404 (discussion 409)

    Article  CAS  PubMed  Google Scholar 

  53. Engelmyer EI, Belis JA (1996) Long-term ureteroscopic management of low-grade transitional cell carcinoma of the upper urinary tract. Tech Urol 2(2):113–116

    CAS  PubMed  Google Scholar 

  54. Gaboardi F et al (1994) Conservative treatment of upper urinary tract tumors with Nd:YAG laser. J Endourol 8(1):37–41

    Article  CAS  PubMed  Google Scholar 

  55. Schmeller NT, Hofstetter AG (1989) Laser treatment of ureteral tumors. J Urol 141(4):840–843

    CAS  PubMed  Google Scholar 

  56. Rastinehad AR et al (2009) A 20-year experience with percutaneous resection of upper tract transitional carcinoma: is there an oncologic benefit with adjuvant bacillus Calmette Guerin therapy? Urology 73(1):27–31

    Article  PubMed  Google Scholar 

  57. Palou J et al (2004) Percutaneous nephroscopic management of upper urinary tract transitional cell carcinoma: recurrence and long-term followup. J Urol 172(1):66–69

    Article  PubMed  Google Scholar 

  58. Motamedinia P et al. (2015) The expanded use of percutaneous resection for upper tract urothelial carcinoma: a 30-year comprehensive experience. J Endourol 30(3):262–267

    Article  PubMed  Google Scholar 

  59. Roupret M et al (2007) Upper urinary tract transitional cell carcinoma: recurrence rate after percutaneous endoscopic resection. Eur Urol 51(3):709–713 (discussion 714)

    Article  PubMed  Google Scholar 

  60. Goel MC, Mahendra V, Roberts JG (2003) Percutaneous management of renal pelvic urothelial tumors: long-term followup. J Urol 169(3):925–929 (discussion 929–930)

    Article  PubMed  Google Scholar 

  61. Clark PE, Streem SB, Geisinger MA (1999) 13-year experience with percutaneous management of upper tract transitional cell carcinoma. J Urol 161(3):772–775 (discussion 775–776)

    Article  CAS  PubMed  Google Scholar 

  62. Patel A et al (1996) Long-term outcome after percutaneous treatment of transitional cell carcinoma of the renal pelvis. J Urol 155(3):868–874

    Article  CAS  PubMed  Google Scholar 

  63. Plancke HR, Strijbos WE, Delaere KP (1995) Percutaneous endoscopic treatment of urothelial tumours of the renal pelvis. Br J Urol 75(6):736–739

    Article  CAS  PubMed  Google Scholar 

  64. Fuglsig S, Krarup T (1995) Percutaneous nephroscopic resection of renal pelvic tumors. Scand J Urol Nephrol Suppl 172:15–17

    CAS  PubMed  Google Scholar 

  65. Tasca A, Zattoni F, Garbeglio A, Villi G, Bassi P, Meneghini A (1992) Endourologic treatment of transitional cell carcinoma of the upper urinary tract. J Endourol 6(3):253–256

    Article  Google Scholar 

  66. Johnson GB, Fraiman M, Grasso M (2005) Broadening experience with the retrograde endoscopic management of upper urinary tract urothelial malignancies. BJU Int 95(Suppl. 2):110–113

    Article  PubMed  Google Scholar 

  67. Keeley FX Jr, Bibbo M, Bagley DX (1997) Ureteroscopic treatment and surveillance of upper urinary tract transitional cell carcinoma. J Urol 157(5):1560–1565

    Article  PubMed  Google Scholar 

  68. Aboumarzouk OM et al (2013) Mitomycin C instillation following ureterorenoscopic laser ablation of upper urinary tract carcinoma. Urol Ann 5(3):184–189

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. O’Brien T et al (2011) Prevention of bladder tumours after nephroureterectomy for primary upper urinary tract urothelial carcinoma: a prospective, multicentre, randomised clinical trial of a single postoperative intravesical dose of mitomycin C (the ODMIT-C Trial). Eur Urol 60(4):703–710

    Article  PubMed  Google Scholar 

  70. Ito A et al (2013) Prospective randomized phase II trial of a single early intravesical instillation of pirarubicin (THP) in the prevention of bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma: the THP Monotherapy Study Group Trial. J Clin Oncol 31(11):1422–1427

    Article  CAS  PubMed  Google Scholar 

  71. Wagenheim GN, Papadopoulos J, Navai N, Davis JW, Karam JA, Kamat AM, Wood CG, Dinney CP, Matin SF (2016) Mitomycin-c induction and maintenance topical therapy for upper tract urothelial carcinoma. In: Presented at GU symposium, January 8, San Francisco, CA, USA

  72. Lifshitz D (2014) Hydrogel based drug retention system for the treatment of upper tract urothelial carcinoma. Eur Urol Suppl 1(13):e26

    Google Scholar 

  73. Goel MC et al (2006) Partial nephrectomy for renal urothelial tumors: clinical update. Urology 67(3):490–495

    Article  PubMed  Google Scholar 

  74. Linton KD et al (2013) Disease specific mortality in patients with low risk bladder cancer and the impact of cystoscopic surveillance. J Urol 189(3):828–883

    Article  PubMed  Google Scholar 

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Acknowledgments

The senior author would like to recognize support from the Monteleone Family Foundation for Research in Kidney and Bladder Cancer.

Authors’ contributions

Mandalapu, Matin was involved in protocol/project development, data collection or management, data analysis and manuscript writing/editing. Remzi, De Reijke, Margulis, Palou, Kapoor, Yossepowitch, Coleman, Traxer, Anderson, Catto, de la Rosette, O’Brien and Zlotta took part in data collection or management, data analysis and manuscript writing/editing.

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Authors and Affiliations

  1. Houston, TX, USA

    Rao S. Mandalapu

  2. LKH Korneuburg, Korneuburg, Austria

    Mesut Remzi

  3. AMC University Hospital, Amsterdam, The Netherlands

    Theo M. de Reijke & Jean de la Rosette

  4. Department of Urology, University of Texas Southwestern, Dallas, TX, USA

    Vitaly Margulis

  5. Fundacio Puigvert, Barcelona, Spain

    J. Palou

  6. McMaster University, Hamilton, ON, Canada

    A. Kapoor

  7. Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel

    Ofer Yossepowitch

  8. Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jonathan Coleman

  9. Hôpital Tenon, Université Pierre et Marie Curie Paris 6, Paris, France

    Olivier Traxer

  10. University of Minnesota Medical Center, Minneapolis, MN, USA

    J. Kyle Anderson

  11. Academic Urology Unit, University of Sheffield, Sheffield, UK

    James Catto

  12. Guy’s and St. Thomas’ NHS Foundation Trust, London, UK

    Timothy O’Brien

  13. Mt. Sinai Hospital, Toronto, ON, Canada

    Anthony Zlotta

  14. Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA

    Surena F. Matin

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  1. Rao S. Mandalapu
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  2. Mesut Remzi
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  15. Surena F. Matin
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Correspondence to Surena F. Matin.

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This review does not involve human subjects and meets Helsinki Declaration for protection of human subjects.

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Mandalapu, R.S., Remzi, M., de Reijke, T.M. et al. Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of low-risk upper tract urothelial carcinoma. World J Urol 35, 355–365 (2017). https://doi.org/10.1007/s00345-016-1859-6

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