Context

The European Association of Urology (EAU) Guidelines Panel on Upper Urinary Tract Urothelial Carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the current evidence-based management of UTUC and to incorporate recommendations into clinical practice.

Objective

To provide an overview of the EAU guidelines on UTUC as an aid to clinicians.

Evidence acquisition

The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified following a systematic search of Medline. Data on urothelial malignancies and UTUC were searched using the following keywords: urinary tract cancer; urothelial carcinomas; upper urinary tract, carcinoma; renal pelvis; ureter; bladder cancer; chemotherapy; ureteroscopy; nephroureterectomy; adjuvant treatment; instillation; recurrence; risk factors; and survival. References were weighted by a panel of experts.

Evidence synthesis

Owing to the rarity of UTUC, there are insufficient data to provide strong recommendations (ie, grade A). However, the results of recent multicentre studies are now available, and there is a growing number of retrospective articles in UTUC. The 2017 tumour, node, metastasis (TNM) classification is recommended. Recommendations are given for diagnosis and risk stratification, as well as for radical and conservative treatment; prognostic factors are also discussed. A single postoperative dose of intravesical mitomycin after radical nephroureterectomy reduces the risk of bladder tumour recurrence. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk tumours and two functional kidneys.

Conclusions

These guidelines contain information on the management of individual patients according to a current standardised approach. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen, based on the proposed risk stratification of these tumours.

Patient summary

Urothelial carcinoma of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis; appropriate diagnosis and management is most important. We present recommendations based on current evidence for optimal management.

中文翻译：

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欧洲泌尿外科协会上尿路尿道上皮癌指南：2017年更新

语境

欧洲泌尿外科协会（EAU）上尿路尿道上皮癌（UTUC）指南小组已准备了更新的指南，以帮助临床医生进行当前的UTUC循证管理并将建议纳入临床实践。

客观的

提供有关UTUC的EAU指南的概述，以帮助临床医生。

取证

当前指南中提供的建议是基于对可用UTUC指南和系统搜索Medline之后发现的文章的全面审查而得出的。使用以下关键词搜索尿路上皮恶性肿瘤和UTUC的数据：尿路上皮癌；上尿路癌 肾盂; 输尿管; 膀胱癌; 化学疗法 输尿管镜; 肾切除术; 辅助治疗；灌输 复发 风险因素; 和生存。参考文献由专家小组加权。

证据综合

由于UTUC的稀缺性，没有足够的数据来提供有力的建议（即A级）。但是，现在可以获得最近的多中心研究的结果，并且UTUC中的回顾性文章越来越多。建议采用2017年肿瘤，淋巴结转移（TNM）分类。给出了诊断和风险分层以及激进和保守治疗的建议；还讨论了预后因素。根治性肾切除术后单次膀胱内丝裂霉素剂量可降低膀胱肿瘤复发的风险。对于患有低危肿瘤和两个功能性肾脏的患者，应将保留肾脏的管理作为主要治疗选择。

结论

这些指南包含有关根据当前标准化方法管理个别患者的信息。在确定最佳治疗方案时，泌尿科医师应根据对这些肿瘤的危险分层来考虑每个患者的具体临床特征。

病人总结

上尿路尿道上皮癌很少见，但是因为这些肿瘤中有60％在诊断时是浸润性的；适当的诊断和管理是最重要的。我们根据当前证据提出建议，以实现最佳管理。