The Cancer Behavior and Current Treatment Strategy for Upper Urinary Tract Cancer

Abstract

Upper urinary tract urothelial carcinomas (UTUCs) are rare diseases, accounting for only 5%–10% of all urothelial cancers. Radical nephroureterectomy (RNU) with bladder cuff excision remains the standard care modality of UTUCs. However, the prognosis is poor and the recurrence is high in patients with advanced UTUC treated with RNU currently. Therefore, identifying cancer behavior for UTUC is an important guide for clinical practice. Herein, we provide an overview of cancer behavior of UTUCs, including prognostic factors and clinical cancer courses. We also discuss the appropriate management of patients with UTUC, such as diagnosis, surgical management, and systemic therapies. Due to the rarity of UTUC, strong evidence of management is often lacking. Therefore, further prospective trials are needed, and regular follow-up after interventions is mandatory.

Variant histology is associated with more non‐urothelial tract recurrence but less intravesical recurrence for upper tract urothelial carcinoma after radical nephroureterectomy

“…In the present cohort, chronic kidney disease (CKD) was common in both pure and variant UTUC. Cisplatin‐ineligible status limits the systemic treatment choice, and patients with variant UTUC, who showed poorer oncological outcomes, may require more intensive adjuvant therapy such as radiation to prevent local regional disease control 20,21 …”

“…Cisplatin-ineligible status limits the systemic treatment choice, and patients with variant UTUC, who showed poorer oncological outcomes, may require more intensive adjuvant therapy such as radiation to prevent local regional disease control. 20,21 CKD was a risk factor of urothelial carcinoma and nonmuscle-invasive bladder cancer patients with CKD had worse prognosis and higher tumor recurrence and progression rates than other patients. 22 In our study, eGFR >60 is an independent factor associated with less IVR.…”

MicroRNA‐145‐5p suppresses cell proliferation, migration, and invasion in upper tract urothelial carcinoma by targeting 5‐aminoimidazole‐4‐carboxamide ribonucleotide formyltransferase/IMP cyclohydrolase

“…Urothelial carcinoma (UC) is a malignant tumor comprising urothelial bladder cancer (UCB) and upper tract UC (UTUC) 1 . UTUC is a relatively rare disease, accounting for less than 10% of all UC in Western countries 2,3 . In contrast, UTUC has a high incidence rate in Asia.…”

“…1 UTUC is a relatively rare disease, accounting for less than 10% of all UC in Western countries. 2,3 In contrast, UTUC has a high incidence rate in Asia. In Taiwan, UTUC accounts for 40% of all new UC cases.…”

The prognostic impact of lymphovascular invasion for upper urinary tract urothelial carcinoma: A propensity score-weighted analysis

“…These factors might interfere with the ability to analyze the prognostic impact of LVI. [6,[11][12][13][14] Most previous studies have applied multivariate analysis in retrospective cohorts. However, regression-based approaches, such as Cox regression, may fail to account for the distribution of baseline covariates among patients with and without LVI.…”