Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie · 2019
[French ccAFU guidelines - Update 2018-2020: Upper tract urothelial carcinoma].
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Rouprêt M, Xylinas E, Colin P, Houédé N, Compérat E, Audenet F, Larré S, Masson-Lecomte A, Pignot G, Brunelle S, Roumiguié M, Neuzillet Y, Méjean A
Аннотация
INTRODUCTION: To propose an update of the French guidelines from the national committee ccAFU on upper tract urothelial carcinomas (UTUC).
METHODS: A systematic Medline search was performed between 2016 and 2018, with regards to the diagnosis, the options of treatment and the follow-up of UTUC, to evaluate the different studies with levels of evidence.
RESULTS: The diagnosis of this rare disease is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed for low-risk diseases: unifocal tumour, possible complete resection low-grade and lack of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscopy) in compliant patients is therefore necessary. After RNU, bladder instillation of chemotherapy is recommended in order to reduce the risk of bladder recurrence. An adjuvant chemotherapy is recommended after RNU in pT2-T4 N0-3 M0 disease.
CONCLUSION: These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment of UTUC.
METHODS: A systematic Medline search was performed between 2016 and 2018, with regards to the diagnosis, the options of treatment and the follow-up of UTUC, to evaluate the different studies with levels of evidence.
RESULTS: The diagnosis of this rare disease is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed for low-risk diseases: unifocal tumour, possible complete resection low-grade and lack of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscopy) in compliant patients is therefore necessary. After RNU, bladder instillation of chemotherapy is recommended in order to reduce the risk of bladder recurrence. An adjuvant chemotherapy is recommended after RNU in pT2-T4 N0-3 M0 disease.
CONCLUSION: These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment of UTUC.