Risk stratification for kidney sparing procedure in upper tract urothelial carcinoma

Abstract

Risk stratification for kidney sparing procedures (KSP) to treat upper tract urothelial carcinoma (UTUC) is a major issue. A non-systematic Medline/PubMed literature search was performed using the terms “upper tract urothelial carcinoma” with different combinations of keywords to review the current knowledge on this topic. Original articles, reviews and editorials in English language were selected based on their clinical relevance. Available techniques for KSP include segmental ureterectomy and endoscopic resection through a percutaneous or flexible ureteroscopic access. These approaches were traditionally restricted to patients with imperative indications. Current recommendations suggest that selected patients with normal contralateral kidney should also be candidates for such treatments. Modern imaging and endoscopy have improved to accurately stage and grade the tumor while various prognostic clinical factors and biomarkers have been proposed to identify tumor with aggressive features and worse outcomes. Several predictive models using different combinations of such baseline characteristics may help clinicians in clinical decision making. However, risk-adapted based approach that has been proposed in recent guidelines to identify patients who are more likely to benefit from KSP only relies on few clinical and pathological factors. Despite growing understanding of the disease, treatment of UTUC remains challenging. Further efforts and collaborative multicenter studies are mandatory to improve risk stratification to decide and promote optimal KSP in UTUC. These efforts should focus on the integration of promising biomarkers and predictive tools in clinical decision making.

Systematic review and meta-analysis of the prognostic value of preoperative platelet-to-lymphocyte ratio in patients with urothelial carcinoma

“…Despite developments in urothelial carcinoma treatment, improving long-term survival remains a major challenge [ 16 , 22 ]. Recent studies have investigated molecular predictors that may facilitate prognostication and individualized therapy [ 23 , 24 ]. Cells and molecules associated with the inflammatory response play an essential role in tumor initiation, progression and invasion [ 19 , 25 ], and have therefore been of particular interest.…”

Contemporary best practice in the management of urothelial carcinomas of the renal pelvis and ureter

“…Since tumour stage is difficult to assess clinically in UTUC, it is useful to ‘risk stratify’ UTUC into low- and high-risk neoplasms to identify those patients who are more suitable for renal sparing treatment versus radical extirpative surgery 16 (Figure 1).…”

“…Uropathologists should look for surgical margins and report positive margins at the level of ureteral transection, bladder cuff, and around the tumour if the T stage >2. 15 Since tumour stage is difficult to assess clinically in UTUC, it is useful to 'risk stratify' UTUC into low-and high-risk neoplasms to identify those patients who are more suitable for renal sparing treatment versus radical extirpative surgery 16 (Figure 1).…”

<p>High aspartate transaminase/alanine transaminase ratio predicts poor prognosis in patients with localized upper tract urothelial cancer: a propensity score-matched study in a large Chinese center</p>

“…For patients with low-risk tumors and two functional kidneys, KSP is recommended the first treatment option. For patients with high-risk cancers, KSP is limited to distal ureteral tumors and imperative cases 1,6. However, risk stratification to discriminate between patients with low- and high-risk tumors remains challenging.…”