Prognostic factors of upper tract urothelial carcinomas and impact on survival: a systematic review for the yearly scientific report of the French National Association of Urology

To describe the main prognostic factors with an impact on survival of patients diagnosed with upper tract urothelial carcinomas (UTUC). A systematic review of the literature has been performed using Pubmed without timeline restriction with the following keywords (MeSH): urothelial carcinoma; ureter; renal pelvis; prognosis; recurrence; survival; predictive models; nomogram. The level of evidence was low (3) in every available studies. There were 4 categories of prognostic factors in UTUCs: clinical (patient and tumor characteristics); surgical; pathological and molecular. The most important pre-operative prognostic factors were: size>3cm, grade (biopsy and cytology); multifocality; important hydronephrosis; co-morbidity (ASA), ECOG status, and a surgical delay of no more than 3months. After surgery, the most important prognostic factors are: stage, grade, carcinoma in situ, lymphovascular invasion and lymph node involvement. Serum markers from inflammation (CRP) could be useful for the prediction of advanced stages. Molecular markers are still under evaluation. The identification of prognostic factors in UTUC has improved over the past years. These prognostic factors can be considered alone but also as a panel or inside predictive tools to predict accurately patient's survival.