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

TY - JOUR

T1 - Predictive tools for clinical decision-making and counseling of patients with upper tract urothelial carcinoma

AU - Xylinas, Evanguelos

AU - Kluth, Luis

AU - Mangal, Sibani

AU - Roupret, Morgan

AU - Karakiewicz, Pierre I

AU - Shariat, Shahrokh F

PY - 2013/2/1

Y1 - 2013/2/1

N2 - 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.

AB - 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.

KW - Carcinoma, Transitional Cell

KW - Counseling

KW - Decision Support Systems, Clinical

KW - Humans

KW - Kidney Neoplasms

KW - Kidney Pelvis

KW - Prognosis

KW - Treatment Outcome

KW - Ureteral Neoplasms

U2 - 10.1007/s00345-012-0947-5

DO - 10.1007/s00345-012-0947-5

M3 - SCORING: Journal article

C2 - 22986907

VL - 31

SP - 31

EP - 36

JO - WORLD J UROL

JF - WORLD J UROL

SN - 0724-4983

IS - 1

ER -