The purpose of this study was to propose an update of the French guidelines from the national committee ccAFU on upper tract urothelial carcinomas (UTUC).
A systematic Medline search for epidemiology, risk factors, diagnosis, prognosis, treatment options and follow-up of UTUC was performed between 2022 and 2024 to evaluate available references and their levels of evidence.
UTUC is a rare malignancy with specific risk factors, including exposure to aristolochic acid and Lynch syndrome. Its diagnosis is based on the use of computed tomography urography and ureterorenoscopy with biopsies. A prognostic classification has been proposed to discriminate low- and high-risk lesions mainly on the basis of tumour grade (low/high) and imaging aspects (non-invasive/invasive). Tumour size (<2/≥2cm), focality (uni-/multifocal), and hydronephrosis (absent/present) are more relative risk factors. The standard of care for low-risk patients is currently conservative treatment involving ureterorenoscopy laser ablation, whereas radical nephroureterectomy (RNU) is advised for those with high-risk disease. Adjuvant treatments after RNU include intravesical instillation of chemotherapy to decrease the risk of bladder recurrence and delivery of platinum-based chemotherapy in pT2-T4 and/or pN+ patients. First-line treatment for metastatic UTUC is based on the combination of enfortumab vedotin plus pembrolizumab. For unfit patients, platinum-based chemotherapy plus nivolumab followed by maintenance nivolumab or platinum-based chemotherapy followed by maintenance avelumab in those with at least stable disease can be proposed. The surveillance regimen and schedule depend on the disease stage.
These updated guidelines will contribute to improving the management of patients diagnosed with UTUC.
The French journal of urology. 2024 Nov [Epub]
Mathieu Roumiguié, Thomas Seisen, Alexandra Masson-Lecomte, Doriane Prost, Y Allory, Evanguelos Xylinas, Priscilla Leon, Anne Sophie Bajeot, Benjamin Pradère, Gautier Marcq, Yann Neuzillet, Constance Thibault, François Audenet, Morgan Rouprêt
Urology Department, Toulouse University Hospital, University of Toulouse UT3, Toulouse, France. Electronic address: ., Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Hôpital Pitié-Salpetrière, 75013 Paris, France., Department of Urology, Hôpital Saint-Louis AP-HP, Université Paris Cité, Paris, France., Urology Department, Paris Saint Joseph Hospital, Sorbonne University, Paris, France., Department of Pathology, Institut Curie, Université Paris Saclay, Saint-Cloud, France., Urology Department, Hôpital Bichat-Claude Bernard AP-HP, Université Paris Cité, Paris, France., Urology Department, Clinique Pasteur, Royan, France., Urology Department, Toulouse University Hospital, University of Toulouse UT3, Toulouse, France., UROSUD Urology Department, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France., Urology Department, Claude Huriez Hospital, CHU Lille, University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, 59000 Lille, France., Urology Department, Hôpital Foch, Université Paris Saclay, Suresnes, France., Medical Oncology Department, Hôpital européen Georges-Pompidou AP-HP centre, Université Paris Cité, Paris, France., Department of Urology, Hôpital Européen Georges-Pompidou AP-HP Centre, Université Paris Cité, Paris, France.