Assessing EAU criteria for high-risk upper tract urothelial carcinoma

Preoperative EAU guideline criteria stratify Upper tract urinary carcinomas (UTUC) into low- and high-risk groups. Depending on this classification, high-risk patients may receive simultaneous lymphadenectomy (LAD) during robot-assisted radical nephroureterectomy (RANU). This study examines the reliability of such stratification, focusing on oncological outcomes.

In 60 patients with UTUC who underwent RANU, 38 were stratified as low-risk (63%) and 22 as high-risk (37%) based on preoperative EAU guideline criteria. LAD was performed solely in the high-risk group.

In the low-risk group, 19 patients (50%) had non-muscle-invasive (Ta, Tis-T1) disease, 7 (18%) had muscle-invasive, locally confined (T2) disease and 12 (32%) had locally advanced (T3/4) disease. In the high-risk group, results were 11 (50%), 3 (14%) and 8 (36%), with no statistical differences observed. Follow-up (6 to 60 months) showed no significant differences in cancer-specific (p = 0.3) and overall survival (p = 0.8) between groups. Limitations: the small sample size and the retrospective nature. Conclusions and Clinical Implications: The current EAU guideline-based preoperative criteria for UTUC risk stratification demonstrated limited accuracy in identifying high-risk patients undergoing RANU, potentially excluding some patients from receiving LAD.

We think that improved preoperative staging and risk stratification tools are needed to better manage patients with upper urinary tract urothelial carcinoma undergoing surgical treatment.