The European Association of Urology provides Clinical Practice Guideline on upper tract urothelial carcinoma (UTUC). Due to the rarity of UTUC, guidelines are necessary to help guide decision-making based on the highest quality of care evidence available.
To evaluate guideline adherence in the management of UTUC by assessing recommendations on diagnostics needed for risk classification and subsequent treatment selection; to assess predictors for the latter.
Data from the Clinical Research Office of the Endo Urology Society UTUC-registry were included for analysis.
Overall compliance were evaluated by cross-tables, differences in risk groups characteristics and treatment selection were assessed by Chi-square tests, predictors for treatment selection by logistic regression analysis.
Data from 2380 patients were included. Imaging by CT-scan had highest adherence (85%) but was low for other diagnostics (17.7-49.7%). Multivariable regression analysis showed higher odds of receiving radical nephroureterectomy in patients with large tumours (OR 5.45, 95% CI 3.77-7.87, p < 0.001), signs of invasion (OR 3.07,CI 2.11-4.46, p < 0.001), high tumour grade (OR 2.05, CI 1.38-3.05, p < 0.001) and multifocality (OR 1.76,CI 1.05-2.97, p =0.032).
CT-imaging is the most used and most impactful decision tool for risk-stratification and treatment selection in UTUC. Due to the low compliance in most of the diagnostic recommendations, proper risk stratification is not possible in a significant group of patients raising the question whether current stratification is deemed applicable in daily practice. Established prognostic factors on survival guides decision-making regarding radical versus kidney-sparing surgery. Tumour size was the most influencing factor on treatment decision.
The study was registered at ClinicalTrials.gov (ClinicalTrials.gov NCT02281188; https://clinicaltrials.gov/ct2/show/NCT02281188 ).
World journal of urology. 2022 Oct 05 [Epub ahead of print]
Joyce Baard, Shahrokh F Shariat, Morgan Roupret, Takashi Yoshida, Alberto Saita, Iliya Saltirov, Javier Revilla Burgos, Orcun Celik, Jean de la Rosette, Pilar Laguna
Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Department of Urology, Medical University of Vienna, Vienna, Austria., Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France., Department of Urology and Andrology, Kansai Medical University, Osaka, Japan., Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria., Department of Urology, Ramon y Cajal Hospital, Alcala University. IRYCIS, Madrid, Spain., Department of Urology, Ekol International Hospital Urology Clinic Izmir, Izmir, Turkey., Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey., Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey. .