Upper urinary tract disease: what we know today and unmet needs (Lynch syndrome patients)

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.....Several tissue, blood, genetic or urine based biomarkers, such as microsatellite instability (MSI) of the tumor, p53, E-cadherin, HIF1alpha, and ki-67 have been proposed to help in the prognostication of UTUC (15). Krabbe et al. reported in 475 patients treated with RNU that Ki-67 was an independent prognosticator of recurrence free survival (RFS) and CSS for high grade tumors (16). Bagrodia et al. similarly demonstrated that both PI3K and cyclin D, two mTOR biomarkers, were associated with adverse pathologic results and worse oncological outcomes in a cohort of 620 patients who underwent RNU or partial ureterectomy (17).
To date, none of these potential biomarkers have been integrated to clinical practice or predictive models.....

 Conclusions
Ten years of intense collaborative efforts in basic and clinical research have made the natural history of UTUC more comprehensible and predictable. Current management is based, however, on low level evidence and there are many challenges to face in the future. There is a need to clarify the role of KSP management, topical agents, LND, and perioperative chemotherapy. New further collaborative efforts are mandatory to propose ambitious multi-institutional studies with preferentially prospective design.