Baard, JoyceShariat, Shahrokh F.Roupret, MorganYoshida, TakashiSaita, AlbertoSaltirov, IliyaBurgos, Javier RevillaÇelik, Orçunde la Rosette, Jean J. M. C. H.del Pilar Laguna Pes, Maria2022-12-152022-12-152022Baard, J., Shariat, S. F., Roupret, M., Yoshida, T., Saita, A., Saltirov, I. ... del Pilar Laguna Pes, M. (2022). Adherence to guideline recommendations in the management of upper tract urothelial carcinoma: An analysis of the CROES-UTUC registry. World Journal of Urology, 40(11), 2755-2763. https://doi.org/10.1007/s00345-022-04168-z0724-49831433-8726https://doi.org/10.1007/s00345-022-04168-zhttps://hdl.handle.net/20.500.12511/10131Background: The European Association of Urology provides Clinical Practice Guideline on upper tract urothelial carcinoma (UTUC). Due to the rarity of UTUC, guidelines are necessary to help guide decision-making based on the highest quality of care evidence available. Objectives: To evaluate guideline adherence in the management of UTUC by assessing recommendations on diagnostics needed for risk classification and subsequent treatment selection; to assess predictors for the latter. Participants: Data from the Clinical Research Office of the Endo Urology Society UTUC-registry were included for analysis. Statistical analysis: Overall compliance were evaluated by cross-tables, differences in risk groups characteristics and treatment selection were assessed by Chi-square tests, predictors for treatment selection by logistic regression analysis. Results: Data from 2380 patients were included. Imaging by CT-scan had highest adherence (85%) but was low for other diagnostics (17.7–49.7%). Multivariable regression analysis showed higher odds of receiving radical nephroureterectomy in patients with large tumours (OR 5.45, 95% CI 3.77–7.87, p < 0.001), signs of invasion (OR 3.07,CI 2.11–4.46, p < 0.001), high tumour grade (OR 2.05, CI 1.38–3.05, p < 0.001) and multifocality (OR 1.76,CI 1.05–2.97, p =0.032). Conclusions: CT-imaging is the most used and most impactful decision tool for risk-stratification and treatment selection in UTUC. Due to the low compliance in most of the diagnostic recommendations, proper risk stratification is not possible in a significant group of patients raising the question whether current stratification is deemed applicable in daily practice. Established prognostic factors on survival guides decision-making regarding radical versus kidney-sparing surgery. Tumour size was the most influencing factor on treatment decision. Clinical trial registration: The study was registered at ClinicalTrials.gov (ClinicalTrials.gov NCT02281188; https://clinicaltrials.gov/ct2/show/NCT02281188).eninfo:eu-repo/semantics/closedAccessClinical Practice GuidelinesGuidelinesUpper Tract Urothelial CarcinomaUrothelial CarcinomaArticle40112755276310.1007/s00345-022-04168-zQ20008643083000012-s2.0-8513944491736197507Q1