Benamran Daniel, Seisen Thomas, Naoum Elias, Vaessen Christophe, Parra Jérome, Mozer Pierre, Shariat Shahrokh F, Rouprêt Morgan
Division of Urology, Geneva University Hospitals, Geneva, Switzerland.
Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Urology Department, Hôpital Pitié-Salpêtrière, F-75013 Paris, France.
Transl Androl Urol. 2020 Aug;9(4):1799-1808. doi: 10.21037/tau.2019.12.21.
Upper tract urinary carcinoma (UTUC) is a heterogeneous group of rare tumors. The aim of this article is to critically review current therapeutic strategies and to propose a change in the risk-stratification of the disease. A non-systematic review of the literature was performed using the Medline database with the search terms: "upper tract urothelial carcinoma" together with "prognostic factor", "risk stratification", "risk factor", "recurrence", "predictive tool", "nomograms" and "treatment". Preoperative risk factors can be viewed as patient-related risk factors (gender, age, ethnicity, body mass index, smoking status, or genetic factors), or tumor-related risk factors (stage, grade, size, architecture, multifocality, ureteric obstruction). Several biomarkers, available either in blood, urine, or the tumor itself have also been proposed. However, many of these prognostic factors lack accuracy and validation in predicting oncological outcomes, despite their use in predictive tools. After risk stratification, kidney-sparing strategies should be considered (endoscopic management and segmental ureterectomy) and could benefit from new diagnostic tools and technical improvements in adjuvant endocavitary instillations. Radical nephroureterectomy remains the first choice therapy for high-grade disease and will probably be associated with other treatments in the future (lymphadenectomy, perioperative chemotherapy, or immunotherapy). In view of the major recent improvements in UTUC treatment strategies, a new classification should be proposed, including low-, intermediate-, high- and very high-risk disease. Subgroup analysis of good quality trials and better understanding of UTUC risk factors will help validate this new approach toward more personalized medicine.
上尿路尿路上皮癌（UTUC）是一组异质性罕见肿瘤。本文旨在对当前的治疗策略进行批判性回顾，并提出对该疾病风险分层的改变。使用Medline数据库对文献进行了非系统性综述，检索词为：“上尿路尿路上皮癌”以及“预后因素”“风险分层”“危险因素”“复发”“预测工具”“列线图”和“治疗”。术前危险因素可分为与患者相关的危险因素（性别、年龄、种族、体重指数、吸烟状况或遗传因素），或与肿瘤相关的危险因素（分期、分级、大小、结构、多灶性、输尿管梗阻）。也有人提出了几种可在血液、尿液或肿瘤本身检测到的生物标志物。然而，尽管这些预后因素被用于预测工具中，但其中许多在预测肿瘤学结局方面缺乏准确性和验证。在进行风险分层后，应考虑保留肾的策略（内镜治疗和节段性输尿管切除术），并且可能受益于新的诊断工具和辅助腔内灌注技术的改进。根治性肾输尿管切除术仍然是高级别疾病的首选治疗方法，并且未来可能会与其他治疗方法联合使用（淋巴结清扫术、围手术期化疗或免疫治疗）。鉴于UTUC治疗策略最近取得的重大进展，应提出一种新的分类方法，包括低、中、高和极高风险疾病。高质量试验的亚组分析以及对UTUC危险因素的更好理解将有助于验证这种更个性化医疗的新方法。
