上尿路尿路上皮癌（upper tract urothelial carcinoma，UTUC）是一种发生在肾盂或输尿管的相对罕见的恶性肿瘤，在精准医疗时代，二代测序等技术进步使人们意识到UTUC具有独特的分子和基因组特征，促进了UTUC治疗管理模式的发展。2024年度上尿路尿路上皮癌诊治领域取得了重要进展，包括影像技术与人工智能大数据的结合应用，新型生物标记物对疾病的非侵入性诊断和监测，机器人时代手术技术的革新，新型靶向治疗药物的开发和高质量临床试验的设计，UTUC的个体化诊疗正逐步落地，为UTUC患者提供新的治疗希望。

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[1] SORIA F, SHARIAT SF, LERNER SP, et al. Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper- tract urothelial carcinoma (UTUC) [J]. World J Urol, 2017, 35(3): 379-387.

[2] 中国医师协会泌尿外科医师分会肿瘤专业委员会and中国医师协会泌尿外科医师分会上尿路尿路上皮癌协作组. 上尿路尿路上皮癌诊断与治疗中国专家共识[J]. 中华泌尿外科杂志, 2018, 39(7): 485-488.

[3] PETROSFG. Epidemiology, clinical presentation, and evaluation of upper-tract urothelial carcinoma [J]. Transl Androl Urol, 2020, 9(4): 1794-1798.

[4] JAIME-CASAS S, TRIPATHI A, PAL SK, et al. Clinical Implications of the Molecular and Genomic Landscape of Upper Tract Urothelial Carcinoma [J]. Curr Urol Rep, 2024, 26(1): 11.

[5] FUJII Y, SATO Y, SUZUKI H, et al. Molecular classification and diagnostics of upper urinary tract urothelial carcinoma [J]. Cancer Cell, 2021, 39(6): 793-809.e8.

[6] NALLY E, YOUNG M, CHAUHAN V, et al. Upper Tract Urothelial Carcinoma (UTUC): Prevalence, Impact and Management Challenge [J]. Cancer Manag Res, 2024, 16: 467-475.

[7] MESSINA E, PROIETTI F, LASCHENA L, et al. MRI for risk stratification of muscle invasion by upper tract urothelial carcinoma: a feasibility study [J]. Eur Radiol Exp, 2024, 8(1): 9.

[8] ALMÅS B, REISÆTER LAR, MARKHUS CE, et al. A preoperative magnetic resonance imaging can aid in staging and treatment choice for upper tract urothelial carcinoma [J]. BJUI Compass, 2024, 5(12): 476-482.

[9] VOSKUILEN CS, SCHWEITZER D, JENSEN JB, et al. Diagnostic Value of (18)F-fluorodeoxyglucose Positron Emission Tomography with Computed Tomography for Lymph Node Staging in Patients with Upper Tract Urothelial Carcinoma [J].Eur Urol Oncol, 2020, 3(1): 73-79.

[10] ZHANG J, DUAN X, CHEN X, et al. Translational PET Imaging of Nectin- 4 Expression in Multiple Different Cancers with (68)Ga-N188[J]. J Nucl Med, 2024, 65: 12S-18S.

[11] ZENG Z, ZHENG Y, YAN X, et al. On the shoulder of ADC: The development of (124)I- IMMU- 132, an iodine- 124- labelled Trop- 2- targeting molecular probe for microPET imaging [J]. Biomed Pharmacother, 2024, 178: 117151.

[12] ZHAI X, SUN P, YU X, et al. CT- based radiomics signature for differentiating pyelocaliceal upper urinary tract urothelial carcinoma from infiltrative renal cell carcinoma [J]. Front Oncol, 2023, 13: 1244585.

[13] ALQAHTANI A, BHATTACHARJEE S, ALMOPTI A, et al. Radiomics- Based Computed Tomography Urogram Approach for the Prediction of Survival and Recurrence in Upper Urinary Tract Urothelial Carcinoma [J]. Cancers (Basel), 2024, 16(18): 3119.

[14] ZHENG Y, SHI H, FU S, et al. A computed tomography u rog raphy- based m achine lea rning m odel fo r p redic ting preoperative pathological grade of upper urinary tract urothelial carcinoma [J]. Cancer Med, 2024, 13(1): e6901.

[15] Alqahtani A, Bhattacharjee S, Almopti A, et al. Radiomics based machine learning approach for the prediction of grade and stage in upper urinary tract urothelial carcinoma: a step towards virtual biopsy [J]. Int J Surg, 2024, 110(6): 3258-3268.

[16] LU D, REED A, PACE N, et al. Automated Upper Tract Urothelial Carcinoma Tumor Segmentation During Ureteroscopy Using Computer Vision Techniques [J]. J Endourol, 2024, 38(8): 836-842.

[17] ŁASZKIEWICZ J, KRAJEWSKI W, TOMCZAK W, et al. Performance of ChatGPT in providing patient information about upper tract urothelial carcinoma [J]. Contemp Oncol (Pozn), 2024, 28(2): 172-181.

[18] ANGELONI M, VAN DOEVEREN T, LINDNER S, et al. A deep-learning workflow to predict upper tract urothelial carcinoma protein- based subtypes from H&E slides supporting the prioritization of patients for molecular testing [J]. J Pathol Clin Res, 2024, 10(2): e12369.

[19] BHALLA S, PASSARELLI R, BISWAS A, et al. Plasma- Derived Cell- Free DNA as a Biomarker for Early Detection,Prognostication, and Personalized Treatment of Urothelial Carcinoma [J]. J Clin Med, 2024, 13(7):2057.

[20] HUELSTER HL, GOULD B, SCHIFTAN EA, et al. Novel Use of Circulating Tumor DNA to Identify Muscle invasive and Non- organ- confined U pper T ract U rothelial Carcinoma [J]. Eur Urol, 2024, 85(3): 283-292.

[21] TAMURA D, ABE M, HIRAKI H, et al. Postoperative recurrence detection using individualized circulating tumor DNA in upper tract urothelial carcinoma [J]. Cancer Sci, 2024, 115(2): 529-539.

[22] YE J, WANG X, LIAO X, et al. DNA methylation urine test in the diagnosis of upper tract urothelial carcinoma: a systematic review and meta- analysis [J]. Int J Surg, 2025, 111(1): 1255-1264.

[23] BAHLINGER V, BRANZ A, STRISSEL PL, et al. Associations of TACSTD2/TROP2 and NECTIN- 4/NECTIN- 4 with molecular subtypes, PD- L1 expression, and FGFR3 mutational status in two advanced urothelial bladder cancer cohorts [J]. Histopathology, 2024, 84(5): 863-876.

[24] YE J, CHEN Z, LIAO X, et al. HER2 expression in upper tract urothelial carcinoma and the relationship with clinicopathological characteristics- an analysis of 155 patients in Southwest China [J]. World J Urol, 2024, 42(1): 521.

[25] KIM K, ALAM SM, KUO F, et al. Molecular Heterogeneity and Immune Infiltration Drive Clinical Outcomes in Upper Tract Urothelial Carcinoma [J]. Eur Urol, 2024, S0302-2838(24)02686-1.

[26] FUKUMOTO K, KANATANI S, JAREMKO G, et al. Three- dimensional imaging of upper tract urothelial carcinoma improves diagnostic yield and accuracy [J]. JCI Insight, 2024, 9(14): e175751.

[27] DITONNO F, FRANCO A, WU Z, et al. Robot- assisted nephroureterectomy: surgical and mid-term oncological outcomes in over 1100 patients (ROBUUST 2.0 collaborative group) [J]. BJU Int, 2024, 134(6): 967-975.

[28] YONG C, SLAVEN JE, WU Z, et al. The impact of bladder cuff excision on outcomes after nephroureterectomy for upper tract urothelial carcinoma: An analysis of the ROBUUST 2.0 registry [J]. Urol Oncol, 2024, 42(11): 373.e1-373.e7.

[29] TSUBOI I, MATSUKAWA A, KARDOUST PARIZI M, et al. Differential effect of surgical technique on intravesical recurrence after radical nephroureterectomy in patients with upper tract urothelial cancer: a systematic review and Meta analysis [J]. World J Urol, 2024, 42(1): 488.

[30] KAWADA T, LAUKHTINA E, QUHAL F, et al. Oncologic and Safety Outcomes for Endoscopic Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: An Updated Systematic Review and Meta analysis [J]. Eur Urol Focus, 2023, 9(2): 236-240.

[31] PIERORAZIO PM, KLEINMANN N, SHABSIGH A, et al. Long- Term Outcomes of Primary Chemoablation of Low Grade Upper Tract Urothelial Carcinoma With UGN- 101, a Mitomycin Reverse Thermal Gel [J]. J U rol, 2024: 101097ju0000000000004331.

[32] BENSON AB, VENOOK AP, CEDERQUIST L, et al. NCCN Clinical Practice Guidelines in Oncology [J]. J Natl lompr CANC AE, 2017, 15(3):370-398. 2017.

[33] COLEMAN JA, YIP W, WONG NC, et al. Multicenter phase Ⅱ clinical trial of gemcitabine and cisplatin as neoadjuvant chemotherapy for patients with high-grade upper tract urothelial carcinoma [J]. J Clin Oncol, 2023, 41(7): 1618-1625.

[34] L IAO X, BAO Y, WE I Q. PD20- 11 neoadjuvant toripalimab and chemotherapy for locally advanced upper urinary tract carcinoma: a pilot study for a phase Ⅱ trial [J]. J Urol, 2024. 211(5s): e451.

[35] LIAO X, ZHANG P, LIU J, ET AL. 224P WUTSUP-01: Phase Ⅱ trial of neoadjuvant toripalimab and chemotherapy in locally advanced upper tract urothelial carcinoma [J]. Ann Oncol, 2023. 34: S1562.

[36] COLEMAN JA, CLARK PE, BIXLER BR, et al. Diagnosis and management of non- metastatic upper tract urothelial carcinoma: AUA/SUO guideline [J]. J Urol, 2023, 209(5): 1071-1081.

[37] BIRTLE A, JOHNSON M, CHESTER J, et al. Adjuvant chemotherapy in upper tract urothelial carcinoma (the POUT trial): a phase 3, open-label, randomised controlled trial [J]. Lancet, 2020, 395(10220): 1268-1277.

[38] BIRTLE AJ, JONES R, CHESTER J, et al. Improved disease- free survival with adjuvant chem otherapy after nephroureterectomy for upper tract urothelial cancer: final results of the POUT trial [J]. J Clin Oncol, 2024, 42(7): 1466-1471.

[39] BAJOR IN DF, W ITJES JA, GSCHWEND JE, et al. Adjuvant nivolumab versus placebo in muscle-invasive urothelial carcinoma [J]. N Engl J Med, 2021, 384(22): 2102-2114.

 [40] APOLO AB, BALLMAN KV, SONPAVDE G, et al. Adjuvant Pembrolizumab versus Observation in Muscle Invasive Urothelial Carcinoma [J]. N Engl J Med, 2024, 392(1):45-55.

[41] POWLES T, VALDERRAMA BP, GUPTA S, et al. Enfortumab vedotin and pembrolizumab in untreated advanced urothelial cancer [J]. N Engl J Med, 2024, 390(15):875-888.

[42] SHENG X, WANG L, HE Z, et al. Efficacy and Safety of Disitamab Vedotin in Patients With Human Epidermal Growth Factor Receptor 2- Positive Locally Advanced or Metastatic Urothelial Carcinoma: A Combined Analysis of Two Phase Ⅱ Clinical Trials [J]. J Clin Oncol, 2024, 42(12): 1391-1402.

[43] POWLES T, YU EY, LYER G, et al. Phase 2 clinical study evaluating the efficacy and safety of disitamab vedotin with or without pembrolizumab in patients with HER2- expressing urothelial carcinoma (RC48G001) [J]. J Clin Oncol, 2023. 41: TPS594-TPS594.

[44] GRIVAS P, POUESSEL D, PARK CH, et al. Sacituzumab Govitecan in Combination With Pembrolizumab for Patients With Metastatic Urothelial Cancer That Progressed After Platinum-Based Chemotherapy: TROPHY-U- 01 Cohort 3 [J]. J Clin Oncol, 2024, 42(12): 1415-1425.

[45] LIU MZ, CHEN JY, LYU F, et al. Exploring Radiotherapy as a Promising Alternative for Managing Advanced Upper Tract Urothelial Carcinoma: Rescuing Chemotherapy- Intolerant Patients [J]. Clin Genitourin Cancer, 2024, 22(6): 102203.

陶子豪,关豹,徐纯如,等.2024年上尿路尿路上皮癌诊治进展[J].泌尿外科杂志(电子版),2025,17(1):55-61.DOI:10.20020/j.CNKI.1674-7410.2025.01.08

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尿路上皮癌（urothelial carcinoma，UC）是全球第六大常见的恶性肿瘤。在欧美人群的报道中，仅约10%的患者发生在上尿路，而我国这一比例可能更高，既往中国32家医院的初步调查显示，国人UTUC占比在9.3%~29.9%，平均为17.9%^[1-2]。随着诊断技术的进步，上尿路尿路上皮癌（upper tract urothelial carcinoma，UTUC）的检出率近年来有所上升^[3]。虽然和膀胱癌在临床表现上有相似之处，但是分子和基因组学层面上，其具有不同的特征^[4-5]。这些差异可能解释了UTUC更有侵袭性的生物学行为和对治疗响应与膀胱癌不同的临床现象^[6]。目前，大多数的研究和临床试验设计都集中在膀胱癌中，UTUC的治疗证据部分是由其研究推断的。鉴于UTUC的独特性，应该将其与膀胱癌分别评估。本综述旨在从影像技术创新与人工智能应用、生物标志物与分子诊断、机器人与手术技术创新、药物治疗进展等方面概述2024年UTUC的研究进展。

1 影像技术创新与人工智能应用

2 生物标志物与分子诊断

3 机器人与手术技术创新

4 药物治疗进展

5 挑战与未来方向

虽然2024年关于UTUC的诊断、治疗的管理证据不断涌现，但是因为其低发病率，意味着目前在患者个体化治疗上仍然缺乏高质量的临床证据，对于精准治疗管理仍然面对挑战。

UTUC是一种具有分子异质性的癌症，其生物学差异驱动了不同的临床结局。然而，UTUC分子亚型的探索及其与临床和生物学行为的关联仍需进一步研究。围绕UTUC的分子和基因组特征开展多中心临床试验和研究迫在眉睫。未来，期待通过下一代测序技术、人工智能技术以及发现有效的基因组标志物，精准识别复发转移风险高以及可能从辅助或新辅助治疗中获益的高危UTUC患者。令人鼓舞的是，国内外研究人员正在设计并推进高质量的多中心临床试验，为UTUC患者制定个性化治疗策略不断提供证据支持。

有越来越多的证据证明新辅助治疗的安全性和有效性，但是由于UTUC的解剖位置，术前难以准确的临床分期，这限制了新辅助治疗的推广。通过术前影像学结合人工智能等新兴技术，或通过新型无创生物标记物（如ctDNA）等方法对进展期UTUC的预测，或许未来可以用于选择收益于新辅助治疗的高危UTUC患者。由于UTUC术后患者多伴肾功能不全，这可能会丧失后期药物治疗的机会。随着腔内治疗技术的进步和药物治疗的发展，探索手术保肾策略也是未来发展的方向。同时，探索除了铂类化疗之外的新的术后辅助治疗模式（如放疗、ADC药物、免疫治疗的联合等）也对提高患者预后有重要意义。靶向Nectin-4、Trop2和HER2等抗体偶联药和免疫治疗正在蓬勃发展，随着临床试验的进行和结果的公布，未来UTUC患者可供选择的药物和治疗模式也将越来越多。

本文回顾了2024年UTUC研究领域的研究在影像技术、生物标记物及分子诊断、人工智能辅助、手术技术和药物靶向治疗等领域的进展。新型成像技术和人工智能的结合提高了诊断和分期的准确性，ctDNA等生物标志物推动了无创诊断的发展，全基因组测序和分子靶向治疗为个体化治疗提供了新机遇。这些进展共同推动了UTUC领域的精准医学发展，未来应加强合作和多中心研究，为UTUC的临床实践提供更多高质量的证据。

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