Guidelines

Upper Urinary Tract Urothelial Cell Carcinoma

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2. METHODS

2.1. Data identification

Standard procedure for EAU Guidelines includes an annual assessment of newly published literature in the field to guide future updates. For the 2023 UTUC Guidelines, new and relevant evidence has been identified, collated, and appraised through a structured assessment of the literature. The search was restricted to articles published between June 8th 2021 and May 4th 2022. Databases searched included Pubmed, Ovid, EMBASE and both the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews. After deduplication, a total of 319 unique records were identified, retrieved, and screened for relevance.

Excluded from the search were basic research studies, case series, reports, and editorial comments. The publications identified were mainly retrospective, including some large multicentre studies. Owing to the scarcity of randomised data, articles were selected based on the following criteria: evolution of concepts, intermediate- and long-term clinical outcomes, study quality, and relevance. Older studies were only included if they were historically relevant. A total of 33 new publications were included in the 2023 UTUC Guidelines print. A detailed search strategy is available online: https://uroweb.org/guideline/upper-urinary-tract-urothelial-cell-carcinoma/?type=appendicespublications.

For Chapters 3-6 (Epidemiology, Aetiology and Pathology, Staging and Classification systems, Diagnosis and Prognosis) references used in this text are assessed according to their level of evidence (LE) based on the 2009 Oxford Centre for Evidence-Based Medicine (CEBM) Levels of Evidence [5]. For the Disease Management and Follow-up chapters (Chapters 7 and 8) a system modified from the 2009 CEBM LEs has been used [5]. For each recommendation within the guidelines there is an accompanying online strength rating form which includes the assessment of the benefit to harms ratio and patients‘ preferences for each recommendation. The strength rating forms draws on the guiding principles of the GRADE methodology but do not purport to be GRADE [6,7]. These forms address a number of key elements, namely:

  1. The overall quality of the evidence which exists for the recommendation [5];
  2. the magnitude of the effect (individual or combined effects);
  3. the certainty of the results (precision, consistency, heterogeneity and other statistical or study-related factors);
  4. the balance between desirable and undesirable outcomes;
  5. the impact of patient values and preferences on the intervention;
  6. the certainty of those patient values and preferences.

These key elements are the basis which panels use to define the strength rating of each recommendation. The strength of each recommendation is represented by the words ‘strong’ or ‘weak’. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including certainty of estimates), and nature and variability of patient values and preferences [8].

Additional information can be found in the general Methodology section of this print, and online at the EAU website; https://uroweb.org/guidelines/policies-and-methodological-documents/.

A list of Associations endorsing the EAU Guidelines can also be viewed online at the above address.

2.2. Review

The 2023 UTUC Guidelines have been peer-reviewed prior to publication.