背景:欧洲泌尿外科协会(EAU)上尿路尿路上皮癌(UTUC)指南小组更新了指南,以帮助临床医生对UTUC进行循证管理。
目的:提供关于UTUC的EAU指南的概述,以帮助临床医生。
方法:这些指南中提供的建议是基于通过对PubMed的系统搜索对文献的回顾,奥维德,EMBASE,和Cochrane数据库。使用以下关键词搜索数据:尿路癌,尿路上皮癌,肾盂,输尿管,膀胱癌,化疗,输尿管镜检查,肾输尿管切除术,肿瘤,(neo)辅助治疗,灌输,复发,危险因素,转移性,免疫疗法,和生存。结果由专家小组评估。
结果:即使数据正在累积,对于许多领域,仍然没有足够的高级证据来提供强有力的建议。根据组织学和临床检查(包括影像学检查)对患者进行分层,并评估有Lynch综合征风险的患者将有助于管理。对于低风险UTUC和两个功能性肾脏的患者,应提供保留肾脏的管理作为主要治疗选择。特别是,对于高危或转移性UTUC患者,新的治疗方案已经可用。在高风险的UTUC中,根治性肾输尿管切除术后铂类化疗,和辅助nivolumab不适合或拒绝化疗的患者,是选项。对于转移性疾病,吉西他滨/卡铂化疗被推荐作为顺铂不合格患者的一线治疗方案.PD-1/PD-L1阳性肿瘤患者应提供检查点抑制剂(派姆单抗或阿特珠单抗)。
结论:这些指南包含根据当前最佳证据对个体患者进行管理的信息。泌尿科医师在根据这些肿瘤的风险分层确定最佳治疗方案时,应考虑每位患者的具体临床特征。
结果:上尿路癌很少见,但是因为这些肿瘤中的60%在诊断时是侵入性的,及时和适当的诊断是最重要的。存在许多已知的风险因素。
The European Association of Urology (EAU)
guidelines panel on upper urinary tract urothelial carcinoma (UTUC) has updated the
guidelines to aid clinicians in evidence-based management of UTUC.
To provide an overview of the EAU
guidelines on UTUC as an aid to clinicians.
The recommendations provided in these
guidelines are based on a review of the literature via a systematic search of the PubMed, Ovid, EMBASE, and Cochrane databases. Data were searched using the following keywords: urinary tract cancer, urothelial carcinomas, renal pelvis, ureter, bladder cancer, chemotherapy, ureteroscopy, nephroureterectomy, neoplasm, (neo)adjuvant treatment, instillation, recurrence, risk factors, metastatic, immunotherapy, and survival. The results were assessed by a panel of experts.
Even though data are accruing, for many areas there is still insufficient high-level evidence to provide strong recommendations. Patient stratification on the basis of histology and clinical examination (including imaging) and assessment of patients at risk of Lynch syndrome will aid management. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk UTUC and two functional kidneys. In particular, for patients with high-risk or metastatic UTUC, new treatment options have become available. In high-risk UTUC, platinum-based chemotherapy after radical nephroureterectomy, and adjuvant nivolumab for unfit or patients who decline chemotherapy, are options. For metastatic disease, gemcitabine/carboplatin chemotherapy is recommended as first-line treatment for cisplatin-ineligible patients. Patients with PD-1/PD-L1-positive tumours should be offered a checkpoint inhibitor (pembrolizumab or atezolizumab).
These
guidelines contain information on the management of individual patients according to the current best evidence. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen according to the risk stratification of these tumours.
Cancer of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, timely and appropriate diagnosis is most important. A number of known risk factors exist.