CONTEXT: The European Association of Urology (EAU) guidelines panel on upper urinary tract urothelial carcinoma (UTUC) has updated the guidelines to aid clinicians in evidence-based management of UTUC. OBJECTIVE: To provide an overview of the EAU guidelines on UTUC as an aid to clinicians. EVIDENCE ACQUISITION: The recommendations provided in these guidelines are based on a review of the literature via a systematic search of the PubMed, Ovid, EMBASE, and Cochrane databases. Data were searched using the following keywords: urinary tract cancer, urothelial carcinomas, renal pelvis, ureter, bladder cancer, chemotherapy, ureteroscopy, nephroureterectomy, neoplasm, (neo)adjuvant treatment, instillation, recurrence, risk factors, metastatic, immunotherapy, and survival. The results were assessed by a panel of experts. EVIDENCE SYNTHESIS: Even though data are accruing, for many areas there is still insufficient high-level evidence to provide strong recommendations. Patient stratification on the basis of histology and clinical examination (including imaging) and assessment of patients at risk of Lynch syndrome will aid management. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk UTUC and two functional kidneys. In particular, for patients with high-risk or metastatic UTUC, new treatment options have become available. In high-risk UTUC, platinum-based chemotherapy after radical nephroureterectomy, and adjuvant nivolumab for unfit or patients who decline chemotherapy, are options. For metastatic disease, gemcitabine/carboplatin chemotherapy is recommended as first-line treatment for cisplatin-ineligible patients. Patients with PD-1/PD-L1-positive tumours should be offered a checkpoint inhibitor (pembrolizumab or atezolizumab). CONCLUSIONS: These guidelines contain information on the management of individual patients according to the current best evidence. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen according to the risk stratification of these tumours. PATIENT SUMMARY: Cancer of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, timely and appropriate diagnosis is most important. A number of known risk factors exist.

Department of Translational Medicine Lund University Malmö Sweden; Department of Urology Skåne University Hospital Malmö Sweden

Department of Urology Bichat Claude Bernard Hospital AP HP Université de Paris Paris France

Department of Urology Caritas St Josef Medical Center University of Regensburg Regensburg Germany; Department of Surgical Oncology Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands

Department of Urology Città della Salute e della Scienza University of Torino School of Medicine Torino Italy

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria; Department of Urology La Croix Du Sud Hospital Quint Fonsegrives France

Department of Urology Edinburgh Bladder Cancer Surgery Western General Hospital Edinburgh UK

Department of Urology Freeman Hospital The Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK

Department of Urology Fundación Instituto Valenciano de Oncología Valencia Spain

Department of Urology General Teaching Hospital and 1st Faculty of Medicine Charles University Praha Prague Czechia; Department of Pathology General Hospital of Vienna Medical University of Vienna Vienna Austria

Department of Urology General Teaching Hospital and 1st Faculty of Medicine Charles University Praha Prague Czechia; Department of Pathology General Hospital of Vienna Medical University of Vienna Vienna Austria; Department of Pathology Sorbonne University AP HP Hôpital Tenon Paris

Department of Urology Teaching Hospital Motol and 2nd Faculty of Medicine Charles University Praha Prague Czechia; Department of Urology Comprehensive Cancer Center Medical University Vienna Vienna General Hospital Vienna Austria

Department of Urology The Stokes Centre for Urology Royal Surrey Hospital Guildford UK

Department of Urology Université de Paris AP HP Saint Louis Hospital Paris France

GRC 5 Predictive Onco Uro Sorbonne University AP HP Urology Pitie Salpetriere Hospital Paris France

Lancashire Teaching Hospitals NHS Foundation Trust Preston UK; University of Manchester Manchester UK

Patient advocate Bladder Cancer Norway Norway

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