INTRODUCTION: We assessed the differential performance of imaging modalities predicting pathological response to neoadjuvant chemotherapy (NAC) in urothelial bladder cancer (UBC). MATERIAL AND METHODS: Literature search was conducted using the MEDLINE, SCOPUS, and Cochrane Library in December 2023 to identify eligible studies. RESULTS: Twenty-two studies comprising 1085 patients were selected. The pooled diagnostic odds ratio (DOR), positive likelihood ratio (LR), and negative LR of FDG positron emission tomography-computed tomography (PET/CT) for predicting bladder tumor complete pathological response (CPR) were 17.33 (95% CI: 1.65-180.99), 2.80 (95% CI: 1.04-7.57), and 0.16 (95% CI: 0.02-0.90), respectively. The pooled DOR, positive LR, and negative LR of FDG- PET/CT for predicting lymph node CPR were 5.25 (95% CI: 2.77-9.93), 1.62 (95% CI: 1.20-2.19), and 0.30 (95% CI: 0.22-0.43), respectively. The pooled DOR, positive LR, and negative LR of contrast enhanced magnetic resonance imaging (CEMRI) for predicting bladder tumor CPR were 153 (95% CI: 26.29-890.1), 16.20 (95% CI: 4.19-62.54), and 0.10 (95% CI: 0.04-0.26), respectively. The pooled DOR, positive LR, and negative LR of CEMRI for predicting lymph node CPR were 13.33 (95% CI: 1.06-166.37), 5.62 (95% CI: 0.82-38.53), and 0.42 (95% CI: 0.16-1.06), respectively. CONCLUSIONS: We demonstrated that CEMRI (including mpMRI) helps accurate assessment of response to NAC in UBC. While CEMRI is a useful tool to detect residual tumor in lymph nodes, contrast enhanced CT scan and FDG-PET/CT are precise staging modality to identify nodal metastasis responders to NAC. Nevertheless, this differential diagnostic performance needs to be further refined with radiomics and novel tracers to help individualized clinical decision-making.

• Klíčová slova
• bladder cancer, chemotherapy, radical cystectomy, response rate, urothelial carcinoma,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Non-metastatic upper urinary tract carcinoma (UTUC) is a comparatively rare condition, typically managed with either kidney-sparing surgery (KSS) or radical nephroureterectomy (RNU). Irrespective of the chosen therapeutic modality, patients with UTUC remain at risk of recurrence in the bladder; in patients treated with KSS, the risk of recurrence is high in the remnant ipsilateral upper tract system but there is a low but existent risk in the contralateral system as well as in the chest and in the abdomen/pelvis. For patients treated with RNU for high-risk UTUC, the risk of recurrence in the chest, abdomen, and pelvis, as well as the contralateral UT, depends on the tumor stage, grade, and nodal status. Hence, implementing a risk-stratified, location-specific follow-up is indicated to ensure timely detection of cancer recurrence. However, there are no data on the type and frequency/schedule of follow-up or on the impact of the recurrence type and site on outcomes; indeed, it is not well known whether imaging-detected asymptomatic recurrences confer a better outcome than recurrences detected due to symptoms/signs. Novel imaging techniques and more precise risk stratification methods based on time-dependent probabilistic events hold significant promise for making a cost-efficient individualized, patient-centered, outcomes-oriented follow-up strategy possible. We show and discuss the follow-up protocols of the major urologic societies.

• Klíčová slova
• follow-up, surveillance, upper tract urothelial carcinoma, urothelial carcinoma,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH