Scholarlink

<p>Upper tract urothelial carcinoma (UTUC) is a&#xa0;rare and aggressive malignancy, often diagnosed at an advanced tumor stage. The initial symptoms typically include painless hematuria and/or flank pain. With the increasing use of cross-sectional imaging, UTUC is more frequently detected incidentally. While contrast-enhanced CT–urography reliably detects papillary and large tumors, small or superficial lesions often require ureterorenoscopy for definitive diagnosis. Therapeutic decisions are guided by risk stratification: small, unifocal, low-grade tumors may be managed with nephron-sparing endoscopic laser ablation, though this requires close follow-up surveillance. In contrast, high-risk UTUC—characterized by high-grade histology or invasive disease—should be treated with radical nephroureterectomy, which remains the gold standard. Adjuvant platinum-based chemotherapy significantly improves disease-free survival in invasive tumors. Neoadjuvant regimens and immunotherapy are also gaining importance in the perioperative management of high-risk patients. Moreover, patients with microsatellite instability or <i>FGFR3</i> mutations appear to benefit from biomarker-driven systemic therapies. Given the high risk of recurrence and progression, structured, risk-adapted follow-up is essential. An interdisciplinary, individualized treatment strategy is crucial to providing improved long-term outcomes in this complex disease entity.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Urothelkarzinom des oberen Harntrakts

  • 期刊论文

  • 发表日期：

    2025年11月11日

查看全文
  • Julian Hermans,
  • Marie Semmler,
  • Lennert Eismann

摘要

Upper tract urothelial carcinoma (UTUC) is a rare and aggressive malignancy, often diagnosed at an advanced tumor stage. The initial symptoms typically include painless hematuria and/or flank pain. With the increasing use of cross-sectional imaging, UTUC is more frequently detected incidentally. While contrast-enhanced CT–urography reliably detects papillary and large tumors, small or superficial lesions often require ureterorenoscopy for definitive diagnosis. Therapeutic decisions are guided by risk stratification: small, unifocal, low-grade tumors may be managed with nephron-sparing endoscopic laser ablation, though this requires close follow-up surveillance. In contrast, high-risk UTUC—characterized by high-grade histology or invasive disease—should be treated with radical nephroureterectomy, which remains the gold standard. Adjuvant platinum-based chemotherapy significantly improves disease-free survival in invasive tumors. Neoadjuvant regimens and immunotherapy are also gaining importance in the perioperative management of high-risk patients. Moreover, patients with microsatellite instability or FGFR3 mutations appear to benefit from biomarker-driven systemic therapies. Given the high risk of recurrence and progression, structured, risk-adapted follow-up is essential. An interdisciplinary, individualized treatment strategy is crucial to providing improved long-term outcomes in this complex disease entity.