[Prognostic factors of upper tract urothelial carcinomas and impact on survival: a systematic review for the yearly scientific report of the French National Association of Urology]

Abstract

Aim: To describe the main prognostic factors with an impact on survival of patients diagnosed with upper tract urothelial carcinomas (UTUC).

Material and methods: A systematic review of the literature has been performed using Pubmed without timeline restriction with the following keywords (MeSH): urothelial carcinoma; ureter; renal pelvis; prognosis; recurrence; survival; predictive models; nomogram.

Results: The level of evidence was low (3) in every available studies. There were 4 categories of prognostic factors in UTUCs: clinical (patient and tumor characteristics); surgical; pathological and molecular. The most important pre-operative prognostic factors were: size>3cm, grade (biopsy and cytology); multifocality; important hydronephrosis; co-morbidity (ASA), ECOG status, and a surgical delay of no more than 3months. After surgery, the most important prognostic factors are: stage, grade, carcinoma in situ, lymphovascular invasion and lymph node involvement. Serum markers from inflammation (CRP) could be useful for the prediction of advanced stages. Molecular markers are still under evaluation.

Conclusion: The identification of prognostic factors in UTUC has improved over the past years. These prognostic factors can be considered alone but also as a panel or inside predictive tools to predict accurately patient's survival.

Keywords: Bassinet; Carcinome urothélial; Modèle prédictif; Nomogram; Nomogramme; Predictive models; Prognosis; Pronostic; Recurrence; Renal pelvis; Récidive; Survie; Survival; Ureter; Uretère; Urothelial carcinoma.