The American Urological Association (AUA), in partnership with the Society of Urologic Oncology (SUO), have released recommendations for the diagnosis and management of patients with nonmetastatic upper tract urothelial carcinoma. The new clinical practice guidelines were published by Coleman et al in The Journal of Urology.
Background
Upper tract urothelial carcinoma is a rare disease that occurs in the inner lining of the ureter, calyces, or renal pelvis. Often, both the disease and its treatment pose unique challenges to clinical management and significant risks to patients. While upper tract urothelial carcinoma is not very common, the diagnosis of patients with disease of the renal pelvis is associated with a 5-year mortality rate of over 50%—comparatively worse than the less than 25% 5-year mortality rate for patients with bladder cancer.
"[Upper tract urothelial carcinoma] requires a specialized approach, and there is a need for updated strategies to help this vulnerable patient population," explained lead study author Jonathan Coleman, MD, an attending surgeon at Memorial Sloan Kettering Cancer Center and Chair of the guideline panel. "New information and guidelines like these can help improve cancer control and survival. Clinicians will not only learn how to evaluate patients, but they will get the most up-to-date information on treatment, surveillance, survivorship, and more,” he added.
Overview of New Guidelines
The new guidelines include 38 recommendations and may serve as a useful reference on the effective evidence-based diagnosis and management of nonmetastatic upper tract urothelial carcinoma. They cover:
- Diagnosis and evaluation
- Risk stratification
- Kidney-sparing management
- Surgical management
- Lymph node dissection
- Neoadjuvant/adjuvant chemotherapy and immunotherapy
- Posttreatment surveillance
- Survivorship.
“[The] SUO has been honored to work alongside the AUA to help develop numerous guidelines in urology,” commented Jeffrey Holzbeierlein, MD, FACS, the William L. Valk Endowed Professor and Chair of Urology at the University of Kansas Medical Center, Vice President and Physician-in-Chief at the University of Kansas Cancer Center, and President of the Society of Urologic Oncology. “We believe it’s important to take difficult diagnoses like nonmetastatic [upper tract urothelial carcinoma] and disseminate the most up-to-date information possible,” he concluded.
The full guidelines can be accessed at auanet.org.
Disclosure: For full disclosures of the guideline authors, visit auajournals.org.
