Table Of ContentShahrokh F. Shariat
Evanguelos Xylinas Editors
Upper Tract
Urothelial Carcinoma
123
Upper Tract Urothelial Carcinoma
Shahrokh F. Shariat (cid:129) Evanguelos Xylinas
Editors
Upper Tract Urothelial
Carcinoma
Editors
Shahrokh F. Shariat Evanguelos Xylinas
Department of Urology and Comprehensive Department of Urology
Cancer Center Paris Descartes University
Medical University of Vienna Paris , France
Vienna , Austria
ISBN 978-1-4939-1500-2 ISBN 978-1-4939-1501-9 (eBook)
DOI 10.1007/978-1-4939-1501-9
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2014948335
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Pref ace
In 2014, urothelial carcinoma of the bladder (UCB) is the fi fth most common malig-
nancy and the ninth most common cause of cancer death in the United States [1].
Conversely, upper tract urothelial carcinoma (UTUC) accounts for only 5–10% of
all urothelial carcinomas. Largely due to the relative preponderance of UCB, much
of the clinical decision-making surrounding UTUC is extrapolated from evidence
that is based on UCB patients [2]. In fact, a recent review found 238 randomized
controlled trials in bladder cancer [3], while a systematic search of the best evidence
for the management of UTUC yielded only three such trials which are all very
recent [4]. Notably only one major urological or oncologic association, the EAU
(European Association of Urology), has published guidelines specifi c to UTUC [5].
Another professional organization, the International Consultation on Urological
Diseases (ICUD), is now developing UTUC-specifi c guidelines, while others are
including UTUC still as a subset of UCB guidelines or simply do not address UTUC
in a guideline statement.
While signifi cant similarities exist between UCB and UTUC, ignoring the
important differences may be preventing us from optimizing therapy in patients
with UTUC. Urothelial carcinomas of the lower and upper tract represent, indeed,
two distinct yet related diseases. There are practical, anatomical, biological, and
molecular differences that warrant consideration when risk stratifying and treating
patients with these disparate twin diseases. This is specifi cally the reason for this
book which is the “fi rst” to specifi cally address this important, yet rare, disease.
A s mentioned, there is, unfortunately, little evidence-based data to guide clinical
decision-making in UTUC management. Recently, the tools available for the diag-
nosis and management of UTUC have improved signifi cantly, complementing a
growing understanding of the biology of this disease. To overcome the challenges
that impede progress toward evidence-based medicine in UTUC, focused efforts
based on multicenter collaborative research have augmented our understanding of
this disease promising to improve the care we deliver to our patients.
UTUC requires appropriate management at all stages, since both the cure rate
and morbidity are very sensitive to nuances of treatment. Yet proper risk stratifi ca-
v
vi Preface
tion remains a challenge owing to the diffi culty of clinical staging. This book will
address contemporary concepts and controversies, including the timely and accu-
rate diagnosis of UTUC, emphasizing the integration of pathologic and radiographic
variables for appropriate risk stratifi cation. Important features regarding the natural
history of UTUC will also be emphasized; the role of imaging and endoscopy in
clinical decision-making, diagnosis, staging, and follow-up; and common pathways
of metastatic spread. Up-to-date information regarding boundaries of surgical resec-
tion, indication and extent of lymphadenectomy, clinical staging of UTUC, the role
of perioperative chemotherapy, and optimal management of metastatic disease will
be detailed.
This “fi rst” textbook on UTUC is such organized to give clinicians, healthcare
professionals, researchers, opinion leaders, and patients state-of-the art information
on epidemiologic, basic science, and clinical aspects of UTUC. A group of superb
experts in various aspects of UTUC was assembled all over the world to critically
evaluate the literature and report their experience. We were privileged to work
closely with each contributor and are immensely grateful to them for their time and
dedication. We believe this book will serve as a comprehensive reference on this
important disease that deserves more awareness.
Vienna, Austria Shahrokh F. Shariat, MD
Paris, France Evanguelos Xylinas, MD
References
1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29.
2. Green DA, Rink M, Xylinas E, et al. Urothelial carcinoma of the bladder and the upper tract:
disparate twins. J Urol. 2013;189(4):1214–21.
3. Bachir BG, Shariat SF, Zlotta A, et al. Demographic analysis of randomized controlled trials in
bladder cancer. BJU Int. 2013;111(3):419–26.
4. Matin SF, Shariat SF, Milowsky MI, et al. Highlights from the fi rst symposium on upper tract
urothelial carcinoma. Urol Oncol. 2014;32(3):309–16.
5. Roupret M, Babjuk M, Comperat E, et al. European guidelines on upper tract urothelial carci-
nomas: 2013 update. Eur Urol. 2013;63(6):1059–71.
Contents
1 Epidemiology and Risk Factors for Upper Urinary
Urothelial Cancers .................................................................................... 1
Kathleen G . Dickman, Hans-Martin Fritsche, Arthur P. Grollman,
George N. Thalmann, and James Catto
2 Diagnosis and Evaluation of Upper Tract Urothelial
Carcinoma (UTUC)................................................................................... 31
Pierre Colin, Wassim Kassouf, Badrinath R. Konety, Yair Lotan,
and Morgan Rouprêt
3 Upper Urinary Tract Urothelial Carcinoma Pathology ........................ 45
Kiril Trpkov, Steven Christopher Smith, Premal Patel,
and Mahul B. Amin
4 Prognostics Factors, Molecular Markers, and Predictive Tools
in Upper Tract Urothelial Carcinoma ..................................................... 91
Evanguelos Xylinas, Giacomo Novara, Mesut Remzi,
Pierre Karakiewicz, and Shahrokh F. Shariat
5 Conservative Management of Low-Risk UTUC..................................... 119
Fatima Z. Husain, Mesut Remzi, Vitaly Margulis, Sima P. Porten,
and Surena F. Matin
6 Surgical Management of High-Risk Upper Tract
Urothelial Carcinoma ............................................................................... 131
Georgios Gakis, Ashish M. Kamat, Vitaly Margulis,
Seth P. Lerner, and Arnulf Stenzl
7 The Role of Lymphadenectomy in the Management
of Urothelial Carcinoma of the Upper Urinary Tract ........................... 153
Tsunenori Kondo, Bernard H. Bochner, Siamak Daneshmand,
and Alexandre R. Zlotta
vii
viii Contents
8 Chemotherapy ........................................................................................... 179
Arjun Vasant Balar, Matthew D. Galsky, Arlene O. Siefker-Radtke,
Scott T. Tagawa, and Matthew I. Milowsky
Index ................................................................................................................. 191
Contributors
Mahul B. Amin, MD Department of Pathology and Laboratory Medicine ,
Cedars-Sinai Medical Center , Los Angeles , CA , USA
Arjun Vasant Balar, MD Division of Hematology and Medical Oncology,
NYU Perlmutter Cancer Center , New York , NY , USA
Langone Medical Center , New York University , New York , NY , USA
Bernard H. Bochner, MD, FACS U rology Service, Department of Surgery,
Kimmel Center for Prostate and Urologic Cancers, M emorial Sloan Kettering
Cancer Center , New York , NY , USA
James Catto, MB, ChB, PhD, FRCS(Urol) Academic Urology Unit, University
of Sheffi eld, The Medical School, Sheffi eld, UK
Department of Urology, Sheffi eld Teaching Hospitals, Sheffi eld Cancer Research
Centre , The Medical School , Sheffi eld , Yorkshire , UK
Pierre Colin, MD, PhD Department of Urology , Hôpital Privé de La Louvière,
Générale de Santé, Lille , Lille , France
Siamak Daneshmand, MD Department of Urology , Keck/USC School of
Medicine , Los Angeles , CA , USA
Kathleen G. Dickman, PhD D epartments of Pharmacological Sciences and
Medicine/Nephrology , Stony Brook University , Stonybrook , NY , USA
Hans-Martin Fritsche, MD, PhD, FEBU Department of Urology, Caritas St.
Josef Medical Center , University of Regensburg , Regensburg , Germany
Georgios Gakis, MD, FEBU Department of Urology , University Hospital
Tübingen , Tübingen , Germany
Matthew D. Galsky, MD Mount Sinai School of Medicine, Tisch Cancer Institute,
New York, NY , USA
ix
