Upper Tract Urothelial Carcinoma: A Narrative Review of Current Surveillance Strategies for Non-Metastatic Disease

Abstract

Non-metastatic upper urinary tract carcinoma (UTUC) is a comparatively rare condition, typically managed with either kidney-sparing surgery (KSS) or radical nephroureterectomy (RNU). Irrespective of the chosen therapeutic modality, patients with UTUC remain at risk of recurrence in the bladder; in patients treated with KSS, the risk of recurrence is high in the remnant ipsilateral upper tract system but there is a low but existent risk in the contralateral system as well as in the chest and in the abdomen/pelvis. For patients treated with RNU for high-risk UTUC, the risk of recurrence in the chest, abdomen, and pelvis, as well as the contralateral UT, depends on the tumor stage, grade, and nodal status. Hence, implementing a risk-stratified, location-specific follow-up is indicated to ensure timely detection of cancer recurrence. However, there are no data on the type and frequency/schedule of follow-up or on the impact of the recurrence type and site on outcomes; indeed, it is not well known whether imaging-detected asymptomatic recurrences confer a better outcome than recurrences detected due to symptoms/signs. Novel imaging techniques and more precise risk stratification methods based on time-dependent probabilistic events hold significant promise for making a cost-efficient individualized, patient-centered, outcomes-oriented follow-up strategy possible. We show and discuss the follow-up protocols of the major urologic societies.

Upper Tract Urothelial Cancer: Guideline of Guidelines

“…Moreover, imaging of the upper tract collecting system or ureteroscopy at 3- to 12-month intervals ± abdominal/pelvic CT or MRI with and without contrast are recommended without clear timing. Similar indications for the low-risk malignancies treated with RNU come from the EAU panel, which does not indicate the need for a cystoscopy at 6 months and recommends stopping yearly cystoscopy after 5 years [ 77 , 78 ]. In the case of the kidney-sparing therapeutic approach, the EAU indicates a very stringent follow-up (LE: 3) with an early second-look ureteroscopy after 6 to 8 weeks and cystoscopy and CT-urography at 3 and 6 months and then yearly for 5 years (SE: weak) [ 79 , 80 ].…”

A Comprehensive Review on Upper Tract Urothelial Carcinoma: An Update in 2023

“…All patients with UTUC require a close follow-up after a surgical intervention with curative intent. Klemm et al presented surveillance protocols following definitive therapy for UTUC [9]. The surveillance modalities included urine cytology, cystoscopy, and CT/MR urography, and ureteroscopy (in kidney-sparing surgeries), with intervals varying according to risk stratification and the surgical approach used.…”