Low Compliance With Most Diagnostic Recommendations for Upper Tract Urothelial Carcinoma

Compliance with diagnostic recommendations for upper tract urothelial carcinoma (UTUC) was low, which may interfere with proper risk stratification in most patients, according to findings published in the World Journal of Urology.

“The European Association of Urology provides Clinical Practice Guideline on UTUC,” said Joyce Baard, a urologist affiliated with Amsterdam University Medical Center, and coauthors. “Due to the rarity of UTUC, guidelines are necessary to help guide decision-making based on the highest quality of care evidence available.”

To evaluate guideline adherence, researchers conducted a statistical analysis using data on 2380 patients from the Clinical Research Office of the Endourological Society UTUC registry. Cross-tables, Chi-square tests, and logistic regression analysis were used to understand overall compliance, different characteristics across risk groups, and predictors for treatment selection, respectively.

Among diagnostic techniques, computed tomography (CT) scans had the highest adherence at a rate of 85%. Comparatively, adherence to other diagnostics ranged between 17.7% and 49.7%.

The odds of receiving radical nephroureterectomy were higher in patients with large tumors (OR 5.45, 95% CI 3.77-7.87, P<0.001), signs of invasion (OR 3.07, CI 2.11-4.46, P<0.001), high tumor grade (OR 2.05, CI 1.38-3.05, P<0.001) and multifocality (OR 1.76, CI 1.05-2.97, P=0.032). Study authors noted tumor size was the most significant factor guiding treatment decisions.

For choosing between radical and kidney-sparing surgery, clinical decision-making is guided by established prognostic factors on survival, researchers said.

“Due to the low compliance in most of the diagnostic recommendations, proper risk stratification is not possible in a significant group of patients, raising the question whether current stratification is deemed applicable in daily practice,” investigators concluded.

Reference:
Baard J, Shariat SF, Roupret M, et al. Adherence to guideline recommendations in the management of upper tract urothelial carcinoma: an analysis of the CROES-UTUC registry. World J Urol. Published online ahead of print October 5, 2022. doi:10.1007/s00345-022-04168-z