Predictive tools for clinical decision-making and counseling of patients with upper tract urothelial carcinoma

BACKGROUND: Upper tract urothelial carcinoma (UTUC) is a rare disease with a highly heterogeneous biologic behavior. Accurate individualized prediction of the behavior of UTUC could help guide personalized clinical decision-making regarding optimal therapy.

METHODS: A MEDLINE literature search was performed on UTUC predictive tools. We recorded input variables, prediction form, number of patients used to develop the prediction tools, outcomes being predicted, prediction tool-specific features, predictive accuracy, and whether internal or external validations were performed. Each prediction tool was classified according to the clinical disease state it addressed and the outcome it predicted.

RESULTS: The literature search generated five published tools for UTUC staging and prognostication. None of these prediction tools have undergone external validation yet. Two tools focused on the clinical decision-making regarding conservative management versus radical nephroureterectomy (RNU), lymphadenectomy versus not, and neoadjuvant systemic therapy versus not. Three tools focused on the prognosis after RNU, thereby helping in the decision-making regarding adjuvant systemic chemotherapy.

CONCLUSIONS: Management of UTUC is challenging, and there are no high-level data to guide physicians and patients. Prognostic tools relying on data from large cohorts of patients are currently the best source of information for evidence-based management of UTUC patients.