Risk stratification of upper tract urothelial carcinoma: A Review of the Current Literature

ABSTRACT

Introduction: Several prognostic factors have been identified to risk stratify patients with upper tract urothelial carcinoma (UTUC). However, due to the heterogeneity of these prognosticators and the presence of different therapeutic modalities for this rare and heterogeneous disease, decision-making and patient consulting remains challenging.

Areas covered: A literature search using PubMed, Scopus, Web of Science, and Cochrane Library was conducted in January 2019 to find relevant English-language studies identifying prognostic factors that can help risk stratify patients and select proper therapeutic modality.

Expert opinion: Several studies confirmed the value of patient and tumor-related factors for prognosticating oncological outcomes in UTUC patients. However, due to the retrospective nature of these studies, the true clinical impact needs to be assessed in well-designed prospective-controlled studies to increase the accuracy and fortify the evidence-driven clinical decision-making process. More biomarkers studies for stratifying risks of UTUC patients are needed to capture their biologic and clinical potentials of each individual tumor.

KEYWORDS:

• Urothelial carcinoma
• upper tract urinary carcinoma
• nephroureterectomy
• kidney-sparing surgery
• risk stratification

Article highlights

• UTUC is a rare disease with heterogeneous biology and behavior that needs accurate risk assessment to allow the proper therapy for the right tumor, in the right patient at the right time.

• Current guideline recommendations regarding the management of UTUC are mostly based on retrospective studies with low level of evidence.

• Patients risk stratification using predictive tools including traditional and novel prognosticators is essential to refine patient selection for RNU versus KSS.

• Future well-designed prospective studies are needed to clarify the true prognostic value of novel predictive factors and improve the accuracy of current traditional prognostic models.

Declaration of interest

SF Shariat has a consulting or advisory role for BMS, Ipsen, Jansen, MSD, Olympus, Pierre Fabre, Richard, Roche, Sanochemia, and Urogen related to urothelial carcinoma. The other authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not been funded.