French AFU Cancer Committee Guidelines - Update 2024-2026: Upper urinary tract urothelial cancer (UTUC).

Autor:	Roumiguié M; Urology Department, Toulouse University Hospital, University of Toulouse UT3, Toulouse, France. Electronic address: roumiguie.m@chu-toulouse.fr., Seisen T; Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Hôpital Pitié-Salpetrière, 75013 Paris, France., Masson-Lecomte A; Department of Urology, Hôpital Saint-Louis AP-HP, Université Paris Cité, Paris, France., Prost D; Urology Department, Paris Saint Joseph Hospital, Sorbonne University, Paris, France., Allory Y; Department of Pathology, Institut Curie, Université Paris Saclay, Saint-Cloud, France., Xylinas E; Urology Department, Hôpital Bichat-Claude Bernard AP-HP, Université Paris Cité, Paris, France., Leon P; Urology Department, Clinique Pasteur, Royan, France., Bajeot AS; Urology Department, Toulouse University Hospital, University of Toulouse UT3, Toulouse, France., Pradère B; UROSUD Urology Department, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France., Marcq G; Urology Department, Claude Huriez Hospital, CHU Lille, University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, 59000 Lille, France., Neuzillet Y; Urology Department, Hôpital Foch, Université Paris Saclay, Suresnes, France., Thibault C; Medical Oncology Department, Hôpital européen Georges-Pompidou AP-HP centre, Université Paris Cité, Paris, France., Audenet F; Department of Urology, Hôpital Européen Georges-Pompidou AP-HP Centre, Université Paris Cité, Paris, France., Rouprêt M; Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Hôpital Pitié-Salpetrière, 75013 Paris, France.
Jazyk:	angličtina
Zdroj:	The French journal of urology [Fr J Urol] 2024 Nov; Vol. 34 (12), pp. 102722.
DOI:	10.1016/j.fjurol.2024.102722
Abstrakt:	Introduction: The purpose of this study was to propose an update of the French guidelines from the national committee ccAFU on upper tract urothelial carcinomas (UTUC). Methods: A systematic Medline search for epidemiology, risk factors, diagnosis, prognosis, treatment options and follow-up of UTUC was performed between 2022 and 2024 to evaluate available references and their levels of evidence. Results: UTUC is a rare malignancy with specific risk factors, including exposure to aristolochic acid and Lynch syndrome. Its diagnosis is based on the use of computed tomography urography and ureterorenoscopy with biopsies. A prognostic classification has been proposed to discriminate low- and high-risk lesions mainly on the basis of tumour grade (low/high) and imaging aspects (non-invasive/invasive). Tumour size (<2/≥2cm), focality (uni-/multifocal), and hydronephrosis (absent/present) are more relative risk factors. The standard of care for low-risk patients is currently conservative treatment involving ureterorenoscopy laser ablation, whereas radical nephroureterectomy (RNU) is advised for those with high-risk disease. Adjuvant treatments after RNU include intravesical instillation of chemotherapy to decrease the risk of bladder recurrence and delivery of platinum-based chemotherapy in pT2-T4 and/or pN+ patients. First-line treatment for metastatic UTUC is based on the combination of enfortumab vedotin plus pembrolizumab. For unfit patients, platinum-based chemotherapy plus nivolumab followed by maintenance nivolumab or platinum-based chemotherapy followed by maintenance avelumab in those with at least stable disease can be proposed. The surveillance regimen and schedule depend on the disease stage. Conclusion: These updated guidelines will contribute to improving the management of patients diagnosed with UTUC. (Copyright © 2024. Published by Elsevier Masson SAS.)
Databáze:	MEDLINE
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