影响尿路的尿路上皮癌(UC)被认为是常见的癌症类型之一,发病率排名第五。然而,重要的是要注意,上束UC(UTUC),与膀胱癌(BC)相比,相对罕见,代表少数UC病例,约占5-10%。值得强调的是,多达60%的UTUC病例在诊断时具有侵入性,与25%的BC病例相反。这些统计数据突出表明,迫切需要精心设计,多学科策略来指导这一弱势患者群体的优化管理,旨在控制治疗变异性并最大程度地减少与治疗不足和过度相关的风险。
方法:在本研究中,我们对2023年发布的欧洲泌尿外科协会(EAU)和美国泌尿外科协会/泌尿外科肿瘤学会(AUA/SUO)关于UTUC管理的当代指南进行了比较分析.我们的目标是对比不同的指南,并检查其建议所依据的证据。
结果:通过彻底审查两个组织的指南,我们观察到关于UTUC管理的实质性共识。然而,我们还发现了这些指南之间的明显差异,产生了广泛的建议。这些差异可能源于临床实践的变化,区域偏好,以及资源的可用性。至关重要的是,必须承认,EAU和AUA/SUO的准则都基于各自区域内的最新科学证据和专家共识。
结论:这些发现强调了持续合作的重要性,知识交流,和协调指南,以提高全球UTUC的护理标准。未来的研究应该集中在确定共识领域和弥合不同的国际准则之间的差距,以提高这种具有挑战性的疾病的管理结果。
Urothelial carcinoma (UC) affecting the urinary tract is recognized as one of the prevalent types of cancer, ranking fifth in terms of incidence. However, it is important to note that upper tract urothelial carcinoma (UTUC), in comparison to bladder cancer, is relatively uncommon and represents a minority of UC cases, accounting for ∼5% to 10%. It is worth emphasizing that as much as 60% of UTUC cases are invasive at the time of diagnosis, in contrast to 25% of bladder cancer cases. These statistics highlight the urgent need for well-designed, multidisciplinary strategies to guide optimal management for this vulnerable patient population, aiming to control treatment variability and minimize the risks associated with undertreatment and overtreatment. Methods: In this study, we present a comparative analysis of the contemporary
guidelines on UTUC management from the European Association of Urology (EAU) and the American Urological Association/Society of Urologic Oncology (AUA/SUO) released in 2023. Our objective is to contrast the different guidelines and examine the evidence on which their recommendations are based. Results: By thoroughly reviewing the guidelines from both organizations, we observed substantial agreement on the management of UTUC. However, we also identified noticeable differences among these
guidelines, leading to a wide range of recommendations. These disparities might stem from variations in clinical practices, regional preferences, and the availability of resources. It is crucial to acknowledge that both the EAU and AUA/SUO base their guidelines on the latest scientific evidence and expert
consensus within their respective regions. Conclusions: These findings underscore the importance of ongoing collaboration, knowledge exchange, and harmonization of guidelines to improve the standard of care for UTUC globally. Future research should focus on identifying areas of
consensus and bridging the gaps between different international
guidelines to enhance the management outcomes for this challenging disease.