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.
Cancers. 2023 Dec 20*** epublish ***
Jakob Klemm, Kensuke Bekku, Mohammad Abufaraj, Ekaterina Laukhtina, Akihiro Matsukawa, Mehdi Kardoust Parizi, Pierre I Karakiewicz, Shahrokh F Shariat
Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC H2X 3E4, Canada.