TY - JOUR
T1 - Adherence to guideline recommendations in the management of upper tract urothelial carcinoma
T2 - an analysis of the CROES–UTUC registry
AU - Baard, Joyce
AU - Shariat, Shahrokh F.
AU - Roupret, Morgan
AU - Yoshida, Takashi
AU - Saita, Alberto
AU - Saltirov, Iliya
AU - Burgos, Javier Revilla
AU - Celik, Orcun
AU - de la Rosette, Jean
AU - Laguna, Pilar
N1 - Funding Information: No funds, grants, or other support was received. Publisher Copyright: © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/11
Y1 - 2022/11
N2 - 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).
AB - 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).
KW - Clinical practice guidelines
KW - Guidelines
KW - UTUC
KW - Upper tract urothelial carcinoma
KW - Urothelial carcinoma
UR - http://www.scopus.com/inward/record.url?scp=85139444917&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00345-022-04168-z
DO - https://doi.org/10.1007/s00345-022-04168-z
M3 - Article
C2 - 36197507
SN - 0724-4983
VL - 40
SP - 2755
EP - 2763
JO - World Journal of Urology
JF - World Journal of Urology
IS - 11
ER -