Canadian guidelines for postoperative surveillance of upper urinary tract urothelial carcinoma

Kapoor, Anil; Allard, Christopher B.; Black, Peter C.; Kassouf, Wassim; Morash, Christopher; Rendon, Ricardo

doi:10.5489/cuaj.1578

Cited by 7 publications

(6 citation statements)

References 76 publications

(64 reference statements)

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“…Second, CTU plays an important role in the identification of urothelial tumor recurrence (i.e., contralateral recurrence after nephroureterectomy or nephron sparing procedures) and urinary complications after urinary tract surgery (i.e., urine leakage or stricture at anastomotic site after urinary diversion) and therefore, clinically indicated patients might need to undergo repeated CTU examinations. Third, CTU is one of the CT protocols with a high radiation dose because of wide scan coverage (from the kidney to the bladder neck) and multiple phases ( 17 18 19 ). Therefore, LVLC-CTU with IR demonstrating a comparable diagnostic acceptability despite a significant dose reduction is in line with the “As Low As Reasonably Achievable” principle.…”

Section: Discussionmentioning

confidence: 99%

Low-Tube-Voltage CT Urography Using Low-Concentration-Iodine Contrast Media and Iterative Reconstruction: A Multi-Institutional Randomized Controlled Trial for Comparison with Conventional CT Urography

et al. 2018

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ObjectiveTo compare the image quality of low-tube-voltage and low-iodine-concentration-contrast-medium (LVLC) computed tomography urography (CTU) with iterative reconstruction (IR) with that of conventional CTU.Materials and MethodsThis prospective, multi-institutional, randomized controlled trial was performed at 16 hospitals using CT scanners from various vendors. Patients were randomly assigned to the following groups: 1) the LVLC-CTU (80 kVp and 240 mgI/mL) with IR group and 2) the conventional CTU (120 kVp and 350 mgI/mL) with filtered-back projection group. The overall diagnostic acceptability, sharpness, and noise were assessed. Additionally, the mean attenuation, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and figure of merit (FOM) in the urinary tract were evaluated.ResultsThe study included 299 patients (LVLC-CTU group: 150 patients; conventional CTU group: 149 patients). The LVLC-CTU group had a significantly lower effective radiation dose (5.73 ± 4.04 vs. 8.43 ± 4.38 mSv) compared to the conventional CTU group. LVLC-CTU showed at least standard diagnostic acceptability (score ≥ 3), but it was non-inferior when compared to conventional CTU. The mean attenuation value, mean SNR, CNR, and FOM in all pre-defined segments of the urinary tract were significantly higher in the LVLC-CTU group than in the conventional CTU group.ConclusionThe diagnostic acceptability and quantitative image quality of LVLC-CTU with IR are not inferior to those of conventional CTU. Additionally, LVLC-CTU with IR is beneficial because both radiation exposure and total iodine load are reduced.

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Section: Discussionmentioning

confidence: 99%

Low-Tube-Voltage CT Urography Using Low-Concentration-Iodine Contrast Media and Iterative Reconstruction: A Multi-Institutional Randomized Controlled Trial for Comparison with Conventional CT Urography

et al. 2018

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“…(Expert Opinion) Bladder recurrence after NU for patients with nonmuscle invasive, node-negative UTUC is common and warrants specific follow up for early detection with a schedule of routine surveillance cystoscopy during the first 2 years. 44,45 After 2 years, the frequency can be significantly reduced in patients without recurrences though, as with non-muscle invasive bladder cancer, the duration of surveillance longterm is not clear. 46 Bladder recurrences should be managed according to established guidelines.…”

Section: Surveillance and Survivorshipmentioning

confidence: 99%

Diagnosis and Management of Non-Metastatic Upper Tract Urothelial Carcinoma: AUA/SUO Guideline

et al. 2023

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The purpose of this guideline is to provide a useful reference on the effective evidence-based diagnoses and management of non-metastatic upper tract urothelial carcinoma (UTUC). Materials/Methods: The Pacific Northwest Evidence-based Practice Center of Oregon Health & Science University (OHSU) team conducted searches in Ovid MEDLINE (1946 to March 3rd, 2022, Cochrane Central Register of Controlled Trials (through January 2022), and Cochrane Database of Systematic Reviews (through January 2022). The searches were updated August 2022. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (Table 1). Results: This Guideline provides updated, evidence-based recommendations regarding diagnosis and management of non-metastatic UTUC including risk stratification, surveillance and survivorship. Treatments discussed include kidney sparing management, surgical management, lymph node dissection (LND), neoadjuvant/adjuvant chemotherapy and immunotherapy. Conclusion: This standardized guideline seeks to improve clinicians' ability to evaluate and treat patients with UTUC based on available evidence. Future studies will be essential to further support these statements for improving patient care. Updates will occur as the knowledge regarding disease biology, clinical behavior and new therapeutic options develop.

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“…Many of the principles of management of UTUC therefore have been extrapolated from bladder cancer. The EUA and CUA have published surveillance guidelines but both are based mostly on small single center retrospective series and do not incorporate potential pathologic prognostic variables 1,9,10 . We propose new surveillance guidelines based on a large multi-institutional series of 1029 patients treated with RNU for UTUC.…”

Section: Surveillance Recommendationmentioning

confidence: 99%

“…To date, only the European Association of Urology (EAU) and Canadian Urological Association (CUA) have guidelines on post-operative surveillance of UTUC 1,9,10 . The EAU recommends two surveillance pathways for "invasive" and "non-invasive" tumours (1).…”

Section: Introductionmentioning

confidence: 99%

“…The EAU recommends two surveillance pathways for "invasive" and "non-invasive" tumours (1). The CUA proposes three surveillance protocols based on tumour grade, pathologic T stage, and pathologic node status 10 . Given the emergence of data regarding pathologic prognostic variables and the cost and potential morbidity associated with surveillance, it is prudent to tailor surveillance to patients at differing risk of recurrence.…”

Section: Introductionmentioning

confidence: 99%

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Surveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma

Locke

Hamidizadeh

Kassouf

et al. 2018

CUAJ

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Introduction: Upper tract urothelial carcinoma (UTUC) accounts for 5% of all urothelial tumours. Due to its rarity, evidence regarding postoperative surveillance is lacking. The objective of this study was to develop a post-radical nephroureterectomy (RNU) surveillance protocol based on recurrence patterns in a large multi-institutional cohort of patients. Methods: Retrospective clinical and pathological data were collected from 1029 patients undergoing RNU over a 15-year period (1994-2009) at 10 Canadian academic institutions. A multivariable model was used to identify prognostic clinicopathological factors, which were then used to define risk categories. Risk-based surveillance guidelines were proposed based on actual recurrence patterns. Results: Overall, 555 (49.9%) patients developed recurrence, including 289 (25.9%) in the urothelium and 266 (23.9%) with loco-regional and distant recurrences. Based on multivariable analysis, three risk groups were identified: 1) low-risk patients with pTa-T1, pN0 disease and no adverse histological features (high tumour grade, lymphovascular invasion [LVI], tumour multifocality); 2) intermediate-risk patients with pTa-T1, pN0 disease with one or more of the adverse histological features; and 3) high-risk patients with a ≥pT2 tumour and/or nodal involvement. Low-, intermediate-, and high-risk patients were free of urothelial recurrence at three years in 72%, 66%, and 63%, respectively, and free of regional/distant recurrence in 93%, 87%, and 62%, respectively. The risks of loco-regional and distant recurrences (p<0.0001) and time to death (p<0.0001) were significantly different between the low-, intermediate-, and highrisk patients.

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Canadian guidelines for postoperative surveillance of upper urinary tract urothelial carcinoma

Cited by 7 publications

References 76 publications

Low-Tube-Voltage CT Urography Using Low-Concentration-Iodine Contrast Media and Iterative Reconstruction: A Multi-Institutional Randomized Controlled Trial for Comparison with Conventional CT Urography

Low-Tube-Voltage CT Urography Using Low-Concentration-Iodine Contrast Media and Iterative Reconstruction: A Multi-Institutional Randomized Controlled Trial for Comparison with Conventional CT Urography

Diagnosis and Management of Non-Metastatic Upper Tract Urothelial Carcinoma: AUA/SUO Guideline

Surveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma

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