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Guía clínica para el diagnóstico y tratamiento de los carcinomas de las células uroteliales de las vías urinarias superiores: actualización de 2011

Rouprêt, M.; Zigeuner, R.; Palou, J.; Boehle, A.; Kaasinen, E.; Sylvester, R.; Babjuk, M.; Oosterlinck, W.

Publicado en Actas Urol Esp. 2012;36:2-14. - vol.36 núm 01

Resumen

Contexto

El Grupo de Guías Clínicas sobre el carcinoma de células uroteliales de las vías urinarias superiores (CCU-VUS) de La Asociación Europea de Urología (EAU) ha elaborado una nueva guía clínica para ayudar a los médicos a evaluar el tratamiento del CCU-VUS basado en los datos científicos, y a incorporar las presentes recomendaciones a la práctica clínica diaria.

Objetivo

Este documento ofrece una breve visión general de la guía clínica de la EAU sobre el CCU-VUS como una ayuda para los médicos en su práctica diaria.

Adquisición de datos científicos

Las recomendaciones proporcionadas en la guía actual se basan en una meticulosa revisión de las guías y documentos sobre CCU-VUS disponibles, identificados mediante una búsqueda sistemática en Medline. Los datos sobre neoplasias uroteliales malignas y CCU-VUS en la literatura se buscaron mediante Medline con las siguientes palabras clave: cáncer del tracto urinario, carcinomas uroteliales, tracto urinario superior, carcinoma, células de transición, pelvis renal, uréter, cáncer vesical, quimioterapia, nefroureterectomía, tratamiento adyuvante, tratamiento neoadyuvante, recidiva, factores de riesgo y supervivencia. Un equipo de expertos sopesó las referencias.

Síntesis de los datos científicos

Hay una falta de datos en la literatura actual para proporcionar recomendaciones consistentes, debido a la rareza de la enfermedad. Una serie de recientes estudios multicéntricos ya están disponibles, mientras que las publicaciones anteriores se basaban solo en poblaciones limitadas. Sin embargo, la mayoría de estos estudios han sido análisis retrospectivos. Se recomienda la clasificación TNM2009. Se hacen recomendaciones para el diagnóstico, así como para el tratamiento radical y conservador; también se tratan los factores pronósticos. Se proporcionan recomendaciones para el seguimiento del paciente después de diferentes opciones terapéuticas.

Conclusiones

Esta guía contiene información para el diagnóstico y tratamiento de los pacientes individuales de acuerdo a un enfoque estándar actual. Al determinar el régimen de tratamiento óptimo, los médicos deben tener en cuenta las características clínicas específicas de cada paciente con respecto a la función renal, incluyendo comorbilidades médicas, localización del tumor, grado y estadio y el estado de los marcadores moleculares.

Palabras clave Guías. Carcinoma urotelial. Pronóstico. Marcadores urinarios. Pelvis renal. Uréter. Laparoscopia. Ureteroscopia. Nefroureterectomía.

Introducción

Introducción El resumen más reciente de la guía clínica de la Asociación Europea de Urología (EAU) sobre los carcinomas de células uroteliales de las vías urinarias superiores (CCU-VUS) se publicó en 20041. El Grupo de Guías Clínicas de la EAU, en relación con los CCU-VUS, ha elaborado la presente guía clínica con el fin de ofrecer información basada en datos científicos acerca del tratamiento clínico de estos tumores poco frecuentes, y de ayudar a los médicos a incorporar estas recomendaciones a su práctica clínica. La presente actualización se basa en una búsqueda bibliográfica estructurada. Adquisición de datos científicos Se llevó a cabo una búsqueda en Medline en relación con las neoplasias uroteliales malignas y el tratamiento de los CCU-VUS utilizando combinaciones de los términos siguientes: cáncer de las vías urinarias, carcinomas uroteliales, vías urinarias superiores, carcinoma, células de transición, pelvis renal, uréter, cáncer de vejiga, quimioterapia, nefroureterectomía, tratamiento adyuvante, tratamiento neoadyuvante, recidiva, factores de riesgo y supervivencia. Las publicaciones relativas a los CCU-VUS fueron principalmente retrospectivas, incluidos algunos estudios multicéntricos extensos. Debido a la escasez de datos aleatorizados se seleccionaron artículos para esta guía clínica basándose en los criterios siguientes: evolución de los conceptos, resultados clínicos a medio y largo plazo, calidad del estudio y relevancia. Se incluyeron estudios más antiguos de forma selectiva en caso de ser históricamente relevantes, o de que los datos procedentes de publicaciones recientes fueran escasos. Con objeto de facilitar la evaluación de la calidad de la información facilitada, se han incluido grados de comprobación científica (GCC) y...

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Rouprêt, M.a; Zigeuner, R.b; Palou, J.c; Boehle, A.d; Kaasinen, E.e; Sylvester, R.f; Babjuk, M.g; Oosterlinck, W.h

aDepartamento de Urología, Pitié-Salpétrière Hospital, GHU Est, Assistance-Publique Hôpitaux de Paris, Facultad de Medicina Pierre et Marie Curie, Universidad Paris VI, París, Francia

bDepartamento de Urología, Universidad de Medicina de Graz, Graz, Austria

cDepartamento de Urología, Fundació Puigvert, Barcelona, España

dServicio de Urología, Hospital HELIOS Agnes Karll, 23611 Bad Schwartau, Alemania

eServicio de Urología, Hospital Hyvinkää, Hysinkää, Finlandia

fOrganización Europea para la Investigación y el Tratamiento del Cáncer, Departamento de Bioestadística, Bruselas, Bélgica

gServicio de Urología, Hospital Motol, Segunda Facultad de Medicina, Universidad Charles, Praga, República Checa

hServicio de Urología, Hospital Universitario Ghent, Bélgica

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