Mbeutcha Aurélie, Rouprêt Morgan, Kamat Ashish M, Karakiewicz Pierre I, Lawrentschuk Nathan, Novara Giacomo, Raman Jay D, Seitz Christian, Xylinas Evanguelos, Shariat Shahrokh F
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Department of Urology, University of Nice Sophia-Antipolis, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Nice, France.
World J Urol. 2017 Mar;35(3):337-353. doi: 10.1007/s00345-016-1826-2. Epub 2016 Apr 21.
Upper tract urothelial carcinoma (UTUC) is a rare and heterogeneous disease. Several clinical and biological prognostic factors have been identified in multi-institutional collaborative works with the aim of helping decision-making in pursuit of tailored individual patient care. This review provides an overview of these existing prognostic factors and predictive tools for the management of patients with UTUC.
A systematic literature search was performed using PubMed/MEDLINE, Web of Science and Scopus databases regarding articles published in English between January 2000 and November 2015 according to PRISMA guidelines. Thresholds of 100 and 300 patients were applied for studies on biomarkers and clinical studies, respectively. All the studies on predictive tools were included for analysis. Outcomes of interest were features associated with advanced-stage UTUC, disease recurrence and survival.
A total of 116 studies were included in this review. These large and/or multi-institutional studies have confirmed the prognostic value of standard pathological factors (i.e., tumor stage, grade and lymph node metastasis) and identified novel features such as lymphovascular invasion, tumor architecture, multifocality, concomitant CIS, variant histology and biomarker status among others. Based on these variables, several predictive tools have been developed; however, they often lack of validation. The value of these features and tools needs prospective testing.
Efforts provided by international collaboration groups have permitted to validate established features and identify new features of biologically and clinically aggressive UTUC. Further investigation on prognostic factors and biomarkers is still needed to assess the benefit of these features and tools on clinical decision-making.
上尿路尿路上皮癌（UTUC）是一种罕见且异质性的疾病。在多机构合作研究中已确定了若干临床和生物学预后因素，旨在帮助做出决策以实现针对个体患者的精准治疗。本综述概述了这些现有的UTUC患者管理预后因素和预测工具。
根据PRISMA指南，使用PubMed/MEDLINE、科学网和Scopus数据库对2000年1月至2015年11月期间发表的英文文章进行系统文献检索。关于生物标志物的研究和临床研究分别设定了100例和300例患者的阈值。纳入所有关于预测工具的研究进行分析。感兴趣的结果是与晚期UTUC、疾病复发和生存相关的特征。
本综述共纳入116项研究。这些大型和/或多机构研究证实了标准病理因素（即肿瘤分期、分级和淋巴结转移）的预后价值，并确定了新的特征，如淋巴管侵犯、肿瘤结构、多灶性、伴发原位癌、组织学变异和生物标志物状态等。基于这些变量，已开发了几种预测工具；然而，它们往往缺乏验证。这些特征和工具的价值需要前瞻性测试。
国际合作组所做的努力已证实了既定特征，并确定了具有生物学和临床侵袭性的UTUC的新特征。仍需对预后因素和生物标志物进行进一步研究，以评估这些特征和工具对临床决策的益处。
