Upper Urinary Tract Urothelial Cell Carcinoma

Full Text Guidelines Summary of Changes Scientific Publications & Appendices Pocket Guidelines Archive Panel

2018

Key changes for the 2018 print:

  • Figure 6.2 – Risk stratification of upper urinary tract urothelial carcinoma, tumour size cut off for high-risk UTUC has been changed to > 2 cm;
  • Section 6.6 – Summary of evidence and guidelines for prognosis – recommendation ‘Use the America Society of Anesthesiologists score to assess cancer-specific survival’ – was taken out;
  • Section 7.1.4.3 – Summary of evidence and recommendations for radical nephroureterectomy.
Recommendations Strength rating
Perform radical nephroureterectomy in patients with high-risk tumours. Strong
Technical steps of radical nephroureterectomy:
Offer a post-operative bladder instillation of chemotherapy to lower the intravesical

recurrence rate.

Strong

 

 

  • Section 8.1: Summary of evidence and follow-up of UTUC

 

Recommendations Strength rating
After radical nephroureterectomy:
Low-risk tumours
Perform cystoscopy at three months. If negative, perform subsequent cystoscopy nine months later and then yearly, for five years. Weak

 

Perform computed tomography urography every year for five years. Weak
High-risk tumours
Perform cystoscopy and urinary cytology at three months. If negative, repeat subsequent cystoscopy and cytology every three months for a period of two years, and every six months thereafter until five years, and then yearly. Weak

 

Perform computed tomography urography every six months for two years, and then yearly. Weak

 

After kidney-sparing management:
Low-risk tumours
Perform cystoscopy and computed tomography urography at three and six months, and then yearly for five years. Weak

 

Perform ureteroscopy at three months. Weak
High-risk tumours
Perform cystoscopy, urinary cytology and computed tomography urography at three and six months, and then yearly. Weak

 

Perform ureteroscopy and urinary cytology in situ at three and six months. Weak

 

2017

New relevant references have been identified through a structured assessment of the literature and

incorporated in the various chapters of the 2017 Urothelial Carcinoma of the Upper Urinary Tract Guidelines.

 Key changes for the 2017 print:

New section 3.3.1.1 – Summary of evidence for Chapter 3 (Epidemiology, aetiology and pathology) has been added.

 3.3.1.1     Summary of evidence for histology and classification

Summary of evidence LE
A small proportion of upper tract urothelial carcinoma belong to the tumour spectrum of the hereditary non-polyposis colorectal cancer. 3

New section 5.3 – Summary of evidence section has been added to the Guidelines for the diagnosis of upper tract urothelial carcinoma.

 5.3           Summary of evidence and guidelines for the diagnosis of upper tract urothelial carcinoma

Summary of evidence LE
The diagnosis of urothelial carcinoma of the upper urinary depends on computed tomography urography. 2
Selective urinary cytology has high sensitivity in high-grade tumours including carcinoma in situ. 3

New section 7.1.2.4 – Summary of evidence section has been added to the Guidelines for radical nephroureterectomy. 

7.1.2.4     Summary of evidence and guidelines for radical nephroureterectomy

Summary of evidence LE
Radical nephroureterectomy is the standard in high-risk upper tract urothelial carcinoma, regardless of tumour location. 2
Open and laparoscopic approaches have equivalent efficacy and safety in T1–2/N0 upper tract urothelial carcinoma. 2

 

2016

All chapters of the 2016 Urothelial Carcinomas of the Upper Urinary Tract Guidelines have been updated, based on the 2015 version of the guideline.Conclusions and recommendations have been rephrased and added to, throughout the current document.

Key changes for the 2016 print:

Changed or new conclusions and recommendations can be found in sections:

  • Section 6.2 Molecular markers has been added as a new topic.
  • Section 6.4 Bladder recurrence has been added as a new topic.

New recommendations have been included in Chapter 6 – Prognosis

6.6 Summary of evidence and guidelines for prognosis

Summary of evidence LE
Age, sex and ethnicity are no longer considered as independent prognostic factors. 3
The primary recognised post-operative prognostic factors are tumour stage and grade, extranodal extension and lymphocascular invasion. 3 

 

Recommendation LE GR
Use MSI as an independent molecular prognostic marker to help detect germline mutations and hereditary cancers. 3  C
Use the American Society of Anesthesiologists (ASA) score to assess cancer-specific survival following surgery. 3 C

MSI = Microsatellite instability. 

  • In section 7.1.2.1 Laparoscopic radical nephrectomy, the findings of a systematic review (Oncological outcomes of laparoscopic/robotic radical nephroureterectomy versus open radical nephroureterectomy for UTUC) have been included.
  • Section 7.2.2 Systemic chemotherapy has been expanded.
  • A new algorithm – Figure 7.2 Surgical treatment according to location and risk status – has been included.

2015

The literature for the complete document has been assessed and updated, whenever relevant.

  • Key changes for the 2015 print:
    New algorithms have been included:
    Fig. 3.1: Selection of patients with UTUC for hereditary screening from first medical interview.
    Fig. 6.1: UTUC prognostic factors;
    Fig. 6.2: Risk stratification of UTUC (table presentation in the 2014 print version);
    Fig. 7.1: Proposed flowchart for the management of UTUC was amended.

In Table 7.1. Guidelines for kidney sparing management of low-risk UTUC, the open surgical approach options have been expanded, not resulting in a change in the grade of recommendation (GR).

Surgical open approach
Renal pelvis or calyces:
Partial pyelectomy or partial nephrectomy is seldom indicated.
C
Ureter – Mid & proximal:
Ureteroureterostomy is indicated for tumours that cannot be removed completely endoscopically.
C
Ureter – Distal:
Complete distal ureterectomy and neocystostomy are indicated for tumours in the distal ureter that cannot be removed completely endoscopically.
C

2013

Limited update to include the most recent data.

 

2011

– New topic