The aim was to propose an update of the French Urology Association Cancer Committee (ccAFU) Recommendations on the management of upper urinary tract urothelial carcinomas (UUT-UC).
A systematic Medline search was performed between 2020 and 2022, taking account of the diagnosis, treatment options and follow-up of UUT-UC, while evaluating the references with their levels of evidence.
The diagnosis of this rare pathology is based on CTU acquisition during excretion and flexible ureterorenoscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment. Nevertheless conservative treatment can be discussed for low risk lesions: tumour of low-grade, with no infiltration on imaging, unifocal<2cm, eligible for full treatment therefore requiring close endoscopic surveillance by flexible ureteroscopy in compliant patients. After RNU, postoperative instillation of chemotherapy is recommended to reduce the risk of recurrence in the bladder. Adjuvant chemotherapy has shown clinical benefits compared to surveillance after RNU for tumours (pT2-T4 N0-3 M0).
These updated recommendations should contribute to improving not only patients' level of care, but also the diagnosis and decision-making concerning treatment for UUT-UC.
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2022 Nov [Epub]
Y Neuzillet, T Seisen, O Traxer, Y Allory, F Audenet, P Leon, Y Loriot, B Pradère, M Roumiguié, E Xylinas, A Masson-Lecomte, M Roupret
Service d'urologie, hôpital Foch, Université Paris Saclay, Suresnes, France. Electronic address: ., Sorbonne Université, GRC 5 Predictive Onco-Uro, AP-HP, Urologie, Hôpital Pitié-Salpetrière, 75013 Paris, France., Sorbonne Université, GRC#20 Lithiase Urinaire et EndoUrologie, AP-HP, Urologie, Hôpital Tenon, 75020 Paris, France., Service d'anatomopathologie, Institut Curie, Université Paris Saclay, Saint-Cloud, France., Service d'urologie, Hôpital européen Georges-Pompidou AP-HP Centre, Université Paris Cité, Paris, France., Service d'urologie, clinique Pasteur, Royan, France., Service d'oncologie médicale, Institut Gustave-Roussy, Villejuif, France., Service d'urologie UROSUD, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France., Service d'urologie, CHU de Toulouse, UPS, Université de Toulouse, Toulouse, France., Service d'urologie, Hôpital Bichat-Claude Bernard AP-HP, Université Paris Cité, Paris, France., Service d'urologie, Hôpital Saint-Louis AP-HP, Université Paris Cité, Paris, France.