111 148
Guidelines
European Association of Urology Guidelines on Upper Urinary
Tract Urothelial Carcinoma: 2017 Update
Morgan Roupreˆt
a , b , * , Marko Babjuk c , Eva Compe´rat d , Richard Zigeuner e , Richard J. Sylvester f ,Maximilian Burger
g , Nigel C. Cowan h , Paolo Gontero i , Bas W.G. Van Rhijn j , A. Hugh Mostafid k ,Joan Palou
l , Shahrokh F. Shariat ma
AP-HP, Hôpital La Pitié-Salpétrière, Service d
’
Urologie, Paris, France;
b
UPMC University Paris 06, GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie,
Paris, France;
c
Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Praha, Czech Republic;
d
Department of Pathology,
Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, UPMC Paris VI, Paris, France;
e
Department of Urology, Medical University of Graz, Graz, Austria;
f
European Association of Urology Guidelines Office, Brussels, Belgium;
g
Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg,
Regensburg, Germany;
h
Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK;
i
Division of Urology, Department of Surgical Sciences, Molinette
Hospital, University of Studies of Torino, Turin, Italy;
j
Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek
Hospital, Amsterdam, The Netherlands;
k
Department of Urology, Royal Surrey County Hospital, Guildford, UK;
l
Department of Urology, Fundació Puigvert,
Universidad Autónoma de Barcelona, Barcelona, Spain;
m
Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
E U R O P E A N U R O L O GY 7 3 ( 2 0 18 ) 111 – 1 2 2ava ilable at
www.sciencedirect.comjournal homepage:
www.eu ropeanurology.comArticle info
Article history:
Accepted July 26, 2017
Associate Editor:
James Catto
Keywords:
Urothelial carcinoma
Urinary tract cancer
Risk factors
Ureter
Renal pelvis
Cytology
Ureteroscopy
Nephroureterectomy
Survival
Guidelines
Abstract
Context:
The European Association of Urology (EAU) Guidelines Panel on Upper Urinary
Tract Urothelial Carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the
current evidence-based management of UTUC and to incorporate recommendations into clinical
practice.
Objective:
To provide an overview of the EAU guidelines on UTUC as an aid to clinicians.
Evidence acquisition:
The recommendations provided in the current guidelines are based on a
thorough review of available UTUC guidelines and articles identi
fi
ed following a systematic
search of Medline. Data on urothelial malignancies and UTUC were searched using the following
keywords: urinary tract cancer; urothelial carcinomas; upper urinary tract, carcinoma; renal
pelvis; ureter; bladder cancer; chemotherapy; ureteroscopy; nephroureterectomy; adjuvant
treatment; instillation; recurrence; risk factors; and survival. References were weighted by a
panel of experts.
Evidence synthesis:
Owing to the rarity of UTUC, there are insuf
fi
cient data to provide strong
recommendations (ie, grade A). However, the results of recent multicentre studies are now
available, and there is a growing number of retrospective articles in UTUC. The 2017 tumour,
node, metastasis (TNM) classi
fi
cation is recommended. Recommendations are given for diagno-
sis and risk strati
fi
cation, as well as for radical and conservative treatment; prognostic factors are
also discussed. A single postoperative dose of intravesical mitomycin after radical nephro-
ureterectomy reduces the risk of bladder tumour recurrence. Kidney-sparing management
should be offered as a primary treatment option to patients with low-risk tumours and two
functional kidneys.
Conclusions:
These guidelines contain information on the management of individual patients
according to a current standardised approach. Urologists should take into account the speci
fi
c
clinical characteristics of each patient when determining the optimal treatment regimen, based
on the proposed risk strati
fi
cation of these tumours.
Patient summary:
Urothelial carcinoma of the upper urinary tract is rare, but because 60% of
these tumours are invasive at diagnosis; appropriate diagnosis and management is most
important. We present recommendations based on current evidence for optimal management.
© 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author. Department of Urology, Hospital Pitie´-Salpeˆtrie`re, AP-HP Universite´ Paris 6,
France. Tel. +33 144 495 336; Fax: +33 142 177 354.
E-mail address:
mroupret@gmail.com(M. Roupreˆt).
http://dx.doi.org/10.1016/j.eururo.2017.07.0360302-2838/© 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.