Department of Urology, Stockholm South General Hospital, Stockholm, Sweden.
Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
World J Urol. 2023 Dec;41(12):3395-3403. doi: 10.1007/s00345-023-04530-9. Epub 2023 Aug 4.
To summarise the current knowledge regarding diagnostics, prognostication and follow-up in upper tract urothelial carcinoma (UTUC).
A scoping review combined with expert opinion was applied to provide an overview of the current research field. Based on the published literature and the experts' own experience and opinions, consensus was reached through presentations and discussions at the meeting Consultation on UTUC II in Stockholm 2022.
The strongest prognostic factors in UTUC are tumour grade and stage. They are correlated, and grade is used for indirect staging. The diagnostic examinations should include multiphase computed tomography urography (CTU) with corticomedullary phase, and urethrocystoscopy with cytology. If there is no clear diagnosis for clinical decision-making, ureterorenoscopy (URS) with focal cytology and biopsies should be performed. Both WHO classification systems (1973/1999 and 2004/2016) should be used. Novel biomarker tests are not yet widespread nor recommended for the detection of UTUC. Long-term, regular follow-up, including URS in patients who have had organ-sparing treatment, is important to check for tumour recurrences, intravesical recurrences, metastases and progression of the tumour.
Proper diagnostics with correct grading of UTUC are necessary for appropriate treatment decisions. The diagnostics should include CTU with corticomedullary phase, urine or bladder cytology, URS with focal barbotage cytology, and biopsies when needed for proper diagnosis and risk stratification. Regular, long-term follow-ups are fundamental, due to the high rate of recurrence and risk of progression.
总结上尿路尿路上皮癌（UTUC）的诊断、预后和随访的现有知识。
应用范围综述并结合专家意见，对当前研究领域进行概述。根据已发表的文献以及专家自身的经验和意见，在 2022 年斯德哥尔摩 UTUC II 会议上通过演示和讨论达成共识。
UTUC 最强的预后因素是肿瘤分级和分期。它们相互关联，分级用于间接分期。诊断检查应包括多期 CT 尿路造影（CTU）加皮质髓质期，以及尿道膀胱镜检查加细胞学检查。如果临床决策无明确诊断，应进行输尿管镜检查（URS）加局部细胞学和活检。应同时使用 WHO 两种分类系统（1973/1999 年和 2004/2016 年）。新型生物标志物检测尚未广泛应用，也不推荐用于检测 UTUC。长期、定期随访，包括对接受保器官治疗的患者进行 URS，对于检查肿瘤复发、膀胱内复发、转移和肿瘤进展非常重要。
正确分级的适当诊断对于正确的治疗决策至关重要。诊断应包括 CTU 加皮质髓质期、尿液或膀胱细胞学检查、URS 加局部 barbotage 细胞学检查，以及必要时进行活检以进行正确的诊断和风险分层。由于复发率高且有进展风险，定期、长期随访至关重要。
