Adherence to guideline recommendations in the management of upper tract urothelial carcinoma: an analysis of the CROES-UTUC registry

World J Urol. 2022 Nov;40(11):2755-2763. doi: 10.1007/s00345-022-04168-z. Epub 2022 Oct 5.

Abstract

Background: The European Association of Urology provides Clinical Practice Guideline on upper tract urothelial carcinoma (UTUC). Due to the rarity of UTUC, guidelines are necessary to help guide decision-making based on the highest quality of care evidence available.

Objectives: To evaluate guideline adherence in the management of UTUC by assessing recommendations on diagnostics needed for risk classification and subsequent treatment selection; to assess predictors for the latter.

Participants: Data from the Clinical Research Office of the Endo Urology Society UTUC-registry were included for analysis.

Statistical analysis: Overall compliance were evaluated by cross-tables, differences in risk groups characteristics and treatment selection were assessed by Chi-square tests, predictors for treatment selection by logistic regression analysis.

Results: Data from 2380 patients were included. Imaging by CT-scan had highest adherence (85%) but was low for other diagnostics (17.7-49.7%). Multivariable regression analysis showed higher odds of receiving radical nephroureterectomy in patients with large tumours (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 tumour 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).

Conclusions: CT-imaging is the most used and most impactful decision tool for risk-stratification and treatment selection in UTUC. 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. Established prognostic factors on survival guides decision-making regarding radical versus kidney-sparing surgery. Tumour size was the most influencing factor on treatment decision.

Clinical trial registration: The study was registered at ClinicalTrials.gov (ClinicalTrials.gov NCT02281188; https://clinicaltrials.gov/ct2/show/NCT02281188 ).

Keywords: Clinical practice guidelines; Guidelines; UTUC; Upper tract urothelial carcinoma; Urothelial carcinoma.

Publication types

  • Clinical Study

MeSH terms

  • Carcinoma, Transitional Cell* / diagnostic imaging
  • Carcinoma, Transitional Cell* / therapy
  • Humans
  • Nephroureterectomy / methods
  • Registries
  • Ureteral Neoplasms* / surgery
  • Ureteral Neoplasms* / therapy
  • Urinary Bladder Neoplasms* / surgery
  • Urology*

Associated data

  • ClinicalTrials.gov/NCT02281188