Treatment of upper urinary tract urothelial carcinoma
Mené au Royaume-Uni sur 261 patients atteints d'un carcinome urotélial de la voie excrétrice urinaire supérieure, cet essai de phase III évalue l'efficacité, du point de vue de la survie sans maladie, et la toxicité d'une chimiothérapie adjuvante à base de sels de platine après une néphro-urétérectomie à visée curative (durée médiane de suivi : 30,3 mois)
Upper tract urothelial (transitional cell) carcinoma (UTUC) is a rare malignant disease occurring in roughly two people per 100 000 population. UTUCs comprise 5–10% of urothelial carcinomas overall. A paucity of dedicated high-level evidence has led to extrapolation from studies of urothelial bladder cancer to establish treatment recommendations. Although UTUC biology and clinical features overlap with those of urothelial bladder cancer, differences exist in gene alteration patterns (eg, FGFR3 and HRAS are more frequently altered in UTUC whereas TP53, RB1, and ERBB2 are less frequently mutated), clinical stage at presentation (higher stage at presentation, on average, for patients with UTUC), gender differences (a higher percentage of women get UTUC, although in terms of total numbers they are still in a minority compared with men), and stage-for-stage outcomes (prognosis is poorer for patients with UTUC). As with many rare disease settings, patients with UTUC are disenfranchised because dedicated research is challenging.
The Lancet 2020