Prognostic factors and predictive tools for upper tract urothelial carcinoma: a systematic review.
BACKGROUND
Upper tract urothelial carcinoma (UTUC) is a rare and heterogeneous disease. Several clinical and biological prognostic factors have been identified in multi-institutional collaborative works with the aim of helping decision-making in pursuit of tailored individual patient care. This review provides an overview of these existing prognostic factors and predictive tools for the management of patients with UTUC.


METHODS
A systematic literature search was performed using PubMed/MEDLINE, Web of Science and Scopus databases regarding articles published in English between January 2000 and November 2015 according to PRISMA guidelines. Thresholds of 100 and 300 patients were applied for studies on biomarkers and clinical studies, respectively. All the studies on predictive tools were included for analysis. Outcomes of interest were features associated with advanced-stage UTUC, disease recurrence and survival.


RESULTS
A total of 116 studies were included in this review. These large and/or multi-institutional studies have confirmed the prognostic value of standard pathological factors (i.e., tumor stage, grade and lymph node metastasis) and identified novel features such as lymphovascular invasion, tumor architecture, multifocality, concomitant CIS, variant histology and biomarker status among others. Based on these variables, several predictive tools have been developed; however, they often lack of validation. The value of these features and tools needs prospective testing.


CONCLUSIONS
Efforts provided by international collaboration groups have permitted to validate established features and identify new features of biologically and clinically aggressive UTUC. Further investigation on prognostic factors and biomarkers is still needed to assess the benefit of these features and tools on clinical decision-making.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.|Department of Urology, University of Nice Sophia-Antipolis, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Nice, France.
Aurélie
A
Mbeutcha
Department of Urology, Pitié-Salpétrière Hospital, APHP, University Paris VI, Paris, France.
Morgan
M
Rouprêt
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ashish M
AM
Kamat
Department of Urology, University of Montreal Health Center, Montreal, QC, Canada.
Pierre I
PI
Karakiewicz
Department of Surgical Oncology, Peter MacCallum Cancer Centre and Department of Surgery/Olivia Newton John Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.
Nathan
N
Lawrentschuk
Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy.
Giacomo
G
Novara
Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Jay D
JD
Raman
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Christian
C
Seitz
Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France.
Evanguelos
E
Xylinas
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria. sfshariat@gmail.com.|Department of Urology, Weill Cornell Medical College, New York, NY, USA. sfshariat@gmail.com.|Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. sfshariat@gmail.com.
Shahrokh F
SF
Shariat
D000367:Age Factors; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002278:Carcinoma in Situ / Q000453:epidemiology; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D000066491:Clinical Decision-Making; D018572:Disease-Free Survival; D006801:Humans; D006869:Hydronephrosis / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D007682:Kidney Pelvis / Q000473:pathology / Q000601:surgery*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D009765:Obesity / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment; D012907:Smoking / Q000453:epidemiology; D014516:Ureteral Neoplasms / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology / Q000628:therapy*
D014408:Biomarkers, Tumor
Biomarkers; Disease recurrence; Nomograms; Predictive tools; Prognosis; Prognostic factors; Risk stratification; Survival; Upper tract urothelial carcinoma