Upper Urinary Tract Urothelial Cell Carcinoma

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

ISBN 978-94-92671-13-4

M. Rouprêt, M. Babjuk (Chair), M. Burger (Vice-chair), E. Compérat, N.C. Cowan, P. Gontero, F. Liedberg, A. Masson-Lecomte, A.H. Mostafid, J. Palou, B.W.G. van Rhijn, S.F. Shariat, R. Sylvester
Guidelines Associates: O. Capoun, D. Cohen, J.L. Dominguez-Escrig, T. Seisen, V. Soukup

1.INTRODUCTION

1.1.Aim and scope

The European Association of Urology (EAU) Non-muscle-invasive Bladder Cancer (NMIBC) Guidelines Panel has compiled these clinical guidelines to provide urologists with evidence-based information and recommendations for the management of upper urinary tract urothelial carcinoma (UTUC). Separate EAU guidelines documents are available addressing non-muscle-invasive bladder cancer [1], muscle-invasive and metastatic bladder cancer (MIBC) [2], and primary urethral carcinoma [3].

It must be emphasised that clinical guidelines present the best evidence available to the experts but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions - also taking personal values and preferences/individual circumstances of patients into account. Guidelines are not mandates and do not purport to be a legal standard of care.

1.2.Panel composition

The European Association of Urology (EAU) Guidelines Panel on NMIBC consists of an international multidisciplinary group of clinicians, including urologists, uro-oncologists, a radiologist, a pathologist and a statistician. Members of this panel have been selected based on their expertise and to represent the professionals treating patients suspected of harbouring urothelial carcinoma (UC). All experts involved in the production of this document have submitted potential conflict of interest statements, which can be viewed on the EAU website Uroweb: https://uroweb.org/guideline/upper-urinary-tract-urothelial-cell-carcinoma/.

1.3.Available publications

A quick reference document (Pocket guidelines) is available in print and as an app for iOS and Android devices, presenting the main findings of the UTUC Guidelines. These are abridged versions which may require consultation together with the full text version. Several scientific publications are available as are a number of translations of all versions of the EAU UTUC Guidelines, the most recent scientific summary was published in 2020 [4]. All documents are accessible through the EAU website Uroweb: https://uroweb.org/guideline/upper-urinary-tract-urothelial-cell-carcinoma/.

1.4.Publication history & summary of changes

The first EAU Guidelines on UTUC were published in 2011. This 2021 publication presents a substantial update of the 2020 version.

1.4.1.Summary of changes

The literature for the complete document has been assessed and updated, whenever relevant. Conclusions and recommendations have been rephrased and added to throughout the current document.

Key changes for the 2021 print:

  • Chapter 5 – Diagnosis, new section 5.3 – 18F-Fluorodeoxglucose positron emission tomography/computed tomography (FDT-PET/CT) was added resulting in a change of a recommendation.

5.7 Summary of evidence and guidelines for the diagnosis of UTUC

Recommendation

Strength rating

Magnetic resonance urography or FDG-PET/CT may be used when CT is contra-indicated.

Weak

  • Chapter 6 – Prognosis, additional information has been addeded and this section was restructured, resulting in changes to Figures 6.1 and 6.2 and the Summary of evidence. New sections 6.2.2 – Peri-operative predictive tools for high risk disease and 6.3 – Bladder recurrence were added.

6.4 Summary of evidence and guidelines for the prognosis of UTUC

Summary of evidence

LE

Models are available to predict non-organ confined disease and altered prognosis after RNU.

3

Patient, tumour and treatment-related factors impact risk of bladder recurrence.

3

  • Chapter 7 – Treatment, Sections 7.1.2 – Management of high-risk non-metastatic UTUC and 7.1.3.3 – Induction chemotherapy were added. Section 7.1.5 – Post-operative bladder instillation was expanded, resulting in a changed recommendation.

7.1.6 Summary of evidence and guidelines for the management of high-risk non-metastatic UTUC

Summary of evidence

LE

Post-operative chemotherapy improves disease-free survival.

1b

Recommendation

Strength rating

Offer post-operative systemic platinum-based chemotherapy to patients with muscle-invasive UTUC.

Strong

  • Section 7.2 – Metastatic disease, systemic treatments, considerable new data has been added in both the first-line and second-line setting, not resulting in a change to the recommendations. A change was made to Figure 7.2 – Surgical treatment according to location and status, to include post-operative chemotherapy as an option for high-risk tumours.
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