Guideline Addresses Nonmetastatic Upper Tract Urothelial Carcinoma Management

An American Urological Association/Society of Urologic Oncology guideline published in the Journal of Urology provides more than 3 dozen recommendations to guide clinicians through a current evidence-based approach to the diagnosis and management of nonmetastatic upper tract urothelial carcinoma (UTUC).

UTUC is cancer in the inner lining of the ureter, calyces, or renal pelvis. A diagnosis of UTUC of the renal pelvis carries a 5-year mortality rate of more than 50%, according to the American Urological Association, compared with less than 25% for bladder cancer.

“Although related in pathogenesis to lower tract urothelial cancer (bladder and urethra), UTUC is much less common, only affecting 5%-10% of all patients with urothelial carcinoma,” wrote corresponding author Jonathan A. Coleman, MD, of Memorial Sloan Kettering Cancer Center, New York, New York, and guideline coauthors. “As a rare disease with complex management paradigms, clinicians should have knowledge of patient demographics, staging distribution, and causative factors when evaluating patients with suspected UTUC.”

The guideline is based on evidence through August 2022. Experts from urology and oncology departments in the United States and Canada reviewed existing data and provided recommendations, clinical principles, and expert opinions in the following areas: diagnosis and evaluation, risk stratification, kidney sparing management, surgical management, lymph node dissection, neoadjuvant and adjuvant chemotherapy and immunotherapy, post-treatment surveillance, and survivorship.

“UTUC requires a specialized approach, and there is a need for updated strategies to help this vulnerable patient population,” said Dr Coleman, who served as chair of the guideline panel. “New information and guidelines like these can help improve cancer control and survival. Clinicians will not only learn how to evaluate patients, but they will get the most up to date information on treatment, surveillance, survivorship, and more.”

ReferencesA

Coleman JA, Clark PE, Bixler BR, et al. Diagnosis and management of non-metastatic upper tract urothelial carcinoma: AUA/SUO guideline. J Urol. 2023;209(6):1071-1081. doi:10.1097/JU.0000000000003480

American Urological Association releases non-metastatic upper tract urothelial carcinoma guideline. News release. American Urological Association; April 25, 2023. Accessed October 8, 2024.