Klemm Jakob, Bekku Kensuke, Abufaraj Mohammad, Laukhtina Ekaterina, Matsukawa Akihiro, Parizi Mehdi Kardoust, Karakiewicz Pierre I, Shariat Shahrokh F
Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.
Cancers (Basel). 2023 Dec 20;16(1):44. doi: 10.3390/cancers16010044.
Non-metastatic upper urinary tract carcinoma (UTUC) is a comparatively rare condition, typically managed with either kidney-sparing surgery (KSS) or radical nephroureterectomy (RNU). Irrespective of the chosen therapeutic modality, patients with UTUC remain at risk of recurrence in the bladder; in patients treated with KSS, the risk of recurrence is high in the remnant ipsilateral upper tract system but there is a low but existent risk in the contralateral system as well as in the chest and in the abdomen/pelvis. For patients treated with RNU for high-risk UTUC, the risk of recurrence in the chest, abdomen, and pelvis, as well as the contralateral UT, depends on the tumor stage, grade, and nodal status. Hence, implementing a risk-stratified, location-specific follow-up is indicated to ensure timely detection of cancer recurrence. However, there are no data on the type and frequency/schedule of follow-up or on the impact of the recurrence type and site on outcomes; indeed, it is not well known whether imaging-detected asymptomatic recurrences confer a better outcome than recurrences detected due to symptoms/signs. Novel imaging techniques and more precise risk stratification methods based on time-dependent probabilistic events hold significant promise for making a cost-efficient individualized, patient-centered, outcomes-oriented follow-up strategy possible. We show and discuss the follow-up protocols of the major urologic societies.
非转移性上尿路癌（UTUC）是一种相对罕见的疾病，通常采用保留肾手术（KSS）或根治性肾输尿管切除术（RNU）进行治疗。无论选择何种治疗方式，UTUC患者仍有膀胱复发的风险；在接受KSS治疗的患者中，同侧上尿路残余系统的复发风险较高，但对侧系统以及胸部和腹部/骨盆也存在较低但确实存在的复发风险。对于因高危UTUC接受RNU治疗的患者，胸部、腹部和骨盆以及对侧上尿路的复发风险取决于肿瘤分期、分级和淋巴结状态。因此，需要实施风险分层、部位特异性的随访，以确保及时发现癌症复发。然而，关于随访的类型和频率/时间表，或复发类型和部位对预后的影响，尚无相关数据；实际上，影像学检测到的无症状复发是否比因症状/体征检测到的复发预后更好，目前尚不清楚。基于时间依赖性概率事件的新型成像技术和更精确的风险分层方法，有望实现经济高效的个体化、以患者为中心、以结果为导向的随访策略。我们展示并讨论了主要泌尿外科协会的随访方案。
