Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper-tract urothelial carcinoma (UTUC).
OBJECTIVE
Upper-tract urothelial carcinoma (UTUC) is a relatively uncommon disease with limited available evidence on specific topics. The purpose of this article was to review the previous literature to summarize the current knowledge about UTUC epidemiology, diagnosis, preoperative evaluation and prognostic assessment.


METHODS
Using MEDLINE, a non-systematic review was performed including articles between January 2000 and February 2016. English language original articles, reviews and editorials were selected based on their clinical relevance.


RESULTS
UTUC accounts for 5-10 % of all urothelial cancers, with an increasing incidence. UTUC and bladder cancer share some common risk factors, even if they are two different entities regarding practical, biological and clinical characteristics. Aristolochic acid plays an important role in UTUC pathogenesis in certain regions. It is further estimated that approximately 10 % of UTUC are part of the hereditary non-polyposis colorectal cancer spectrum disease. UTUC diagnosis remains mainly based on imaging and endoscopy, but development of new technologies is rapidly changing the diagnosis algorithm. To help the decision-making process regarding surgical treatment, extent of lymphadenectomy and selection of neoadjuvant systemic therapies, predictive tools based on preoperative patient and tumor characteristics have been developed.


CONCLUSIONS
Awareness regarding epidemiology, diagnosis, preoperative evaluation and prognostic assessment changes is essential to correctly diagnose and manage UTUC patients, thereby potentially improving their outcomes.
Department of Urology, Medical University of Vienna, Vienna, Austria.|Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy.
Francesco
F
Soria
Department of Urology, Medical University of Vienna, Vienna, Austria.|Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.|Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.|Department of Urology, Weill Cornell Medical College, New York, NY, USA.
Shahrokh F
SF
Shariat
Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
Seth P
SP
Lerner
Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany.
Hans-Martin
HM
Fritsche
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Michael
M
Rink
Department of Surgery (Urology), McGill University, Montreal, QC, Canada.
Wassim
W
Kassouf
Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
Philippe E
PE
Spiess
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Yair
Y
Lotan
Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.
Dingwei
D
Ye
Department of Urology, Clinica Alemana, Santiago, Chile.
Mario I
MI
Fernández
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Eiji
E
Kikuchi
Urology Department, University of Sao Paulo Medical School and Institute of Cancer, São Paulo, Brazil.
Daher C
DC
Chade
Department of Urology, Faculty Hospital Motol, Second Faculty of Medicine, Charles University in Praha, Prague, Czech Republic.
Marko
M
Babjuk
Department of Pharmacological Sciences and Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
Arthur P
AP
Grollman
Department of Urology, Bern University Hospital, Bern, Switzerland. george.thalmann@insel.ch.
George N
GN
Thalmann
D034341:Aristolochic Acids / Q000378:metabolism; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000453:epidemiology*; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008197:Lymph Node Excision; D020360:Neoadjuvant Therapy; D011300:Preoperative Care; D011379:Prognosis; D012307:Risk Factors; D014516:Ureteral Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D018666:Ureteroscopy; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology*
D034341:Aristolochic Acids; C000228:aristolochic acid I
Diagnosis; Epidemiology; New technologies; Predictive tools; Prognosis; Risk factor; UTUC