Diagnosis and risk stratification are cornerstones of therapeutic decisions in the management of patients with upper tract urothelial carcinoma (UTUC). Diagnostic modalities provide data that can be integrated, to provide nomograms and stratification tools to predict survival and adverse outcomes. This study reviews cytology, ureterorenoscopy and the novel tools and techniques used with it (including photodynamic diagnosis, narrow-band imaging, optical coherence tomography, and confocal laser endomicroscopy), and biopsy. Imaging modalities and novel biomarkers are discussed in another article. Patient- and tumor-related prognostic factors, their association with survival indices, and their roles in different scores and predictive tools are discussed. Patient-related factors include age, sex, ethnicity, tobacco consumption, surgical delay, sarcopenia, nutritional status, and several blood-based markers. Tumor-related prognosticators comprise stage, grade, presentation, location, multifocality, size, lymphovascular invasion, surgical margins, lymph node status, mutational landscape, architecture, histologic variants, and tumor-stroma ratio. The accuracy and validation of pre-operative predictive tools, which incorporate various prognosticators to predict the risk of muscle-invasive or non-organ confined disease, and help to decide on the surgery type (radical nephroureterectomy, or kidney-sparing procedures) are also investigated. Post-operative nomograms, which help decide on adjuvant chemotherapy and plan follow-up are explored. Finally, a revision of the current stratification of UTUC patients is endorsed.
诊断与风险分层是上尿路尿路上皮癌（UTUC）患者治疗决策的基石。各类诊断方法提供的数据可整合为列线图与分层工具，用于预测患者生存期及不良预后。本研究综述了细胞学检查、输尿管肾镜检查及其相关新型技术与工具（包括光动力诊断、窄带成像、光学相干断层扫描及共聚焦激光显微内镜）以及活检技术的应用。影像学方法与新型生物标志物将在另一篇文章中讨论。本文系统探讨了患者相关与肿瘤相关的预后因素、这些因素与生存指标的关系，以及在不同评分体系和预测工具中的作用。患者相关因素包括年龄、性别、种族、吸烟史、手术延迟、肌肉减少症、营养状况及多种血液标志物；肿瘤相关预后因素涵盖分期、分级、临床表现、肿瘤位置、多灶性、大小、淋巴血管侵犯、手术切缘、淋巴结状态、基因突变谱、组织结构、组织学变异及肿瘤-间质比。研究同时评估了术前预测工具的准确性与验证情况，这些工具整合多种预后因素以预测肌层浸润性或非器官局限性病变的风险，有助于决定手术方式（根治性肾输尿管切除术或保留肾脏手术）。此外，本文还探讨了用于辅助化疗决策及随访规划的术后列线图。最后，研究支持对现行UTUC患者分层体系进行修订完善。
Upper Tract Urothelial Carcinoma (UTUC) Diagnosis and Risk Stratification: A Comprehensive Review
肿瘤(癌症)患者之家