Recent advances in upper tract urothelial carcinomas: From bench to clinics

Abstract

Urothelial carcinoma in the upper tract is rare and often discussed separately. Many established risk factors were identified for the disease, including genetic and external risk factors. Radiographic survey, endoscopic examination and urine cytology remained the most important diagnostic modalities. In localized upper tract urothelial carcinomas, radical nephroureterectomy with bladder cuff excision are the gold standard for large, high‐grade and suspected invasive tumors of the renal pelvis and proximal ureter, whereas kidney‐sparing surgeries should be considered in patients with low‐risk disease. Advances in technology have given endoscopic surgery an important role, not only in diagnosis, but also in treatment. Although platinum‐based combination chemotherapy is efficacious in advanced or metastatic disease, current established chemotherapy regimens are toxic and lack a sustained response. Immune checkpoint inhibitors have led to a new era of treatment for advanced or metastatic urothelial carcinomas. The remarkable results achieved thus far show that immunotherapy will likely be the future treatment paradigm. The combination of immune checkpoint inhibitors and other agents is another inspiring avenue to explore that could benefit even more patients. With respect to the high incidence rate and different clinical appearance of upper tract urothelial carcinomas in Taiwan, a possible correlation exists between exposure to certain external risk factors, such as arsenic in drinking water and aristolochic acid in Chinese herbal medicine. As more gene sequencing differences between upper tract urothelial carcinomas and various disease causes are detailed, this has warranted the era of individualized screening and treatment for the disease.

Immune checkpoint inhibitors in advanced upper and lower tract urothelial carcinoma: a comparison of outcomes

“…Despite morphological similarities, lower and upper tract UC (LTUC, UTUC) have differences in epidemiology, tumour behaviour, molecular characteristics, and prognosis [3][4][5]. These differences may stem from distinct embryological origins, anatomical location, genetic features, discordant staging, and practical considerations in diagnosis and management [6,7]. Data regarding the management of UTUC are limited due to its lower prevalence.…”

Endoscopic Thulium Laser Ablation of Upper Tract Urothelial Carcinoma: a Retrospective Study with Subgroup Analyses

“…Therefore, we selected patients with imperative indications and analyzed the results after laser ablation of UTUC. In our study, female predominance is noted; it is speculated that female patients were highly exposed to arsenic steam during cooking from the boiling water [15]. However, our statistics showed that men had a higher tendency of recurrence with near statistical significance.…”

<p>Optimal Management of Upper Tract Urothelial Carcinoma: Current Perspectives</p>

“…This could be related to the higher exposure of women to arsenic fumes during cooking from the steam generated from boiling water and suggest both inhalation and ingestion risks. 18…”