e and grade [40] .

5.5. Future UTUC Collaborative Research Exploring Molecular Biomarkers

Future research into prognostic biomarkers for UTUC and integration with other clinic-pathological parameters may guide selection for systemic therapies and tailoring of individualized multimodal treatments as well as design of clinical trials. This might potentially improve the management and outcomes of UTUC patients. We started to explore multiple biomarkers involved in different cancer pathways and we found a panel of cell cycle related biomarkers to be promising [41]. Incorporation of biomarkers into clinical practice might potentially allow an enhanced patient counseling, individualized (neo)adjuvant chemotherapy recommendations, and patient-specific surveillance regimens.

6. Conclusion

Despite the refinement of surgical modalities, there was no significant improvement in oncological outcomes after management of UTUC, reflecting the underutilization of multimodal treatment approaches. Understanding the biology of the disease and accurate stratification of patients based on emerging prognostic indicators may enable tailoring more effective multimodal treatments and design of clinical trials. Pathological stage, grade, LVI, tumor architecture are the most important pathological prognostics. Systemic therapy, particularly neoadjuvant chemotherapy, combined with aggressive surgical consolidation might improve oncologic outcomes in high risk UTUC patients.

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NOTES

*Conflict of Interest Statement: None of the authors of this manuscript have any financial or personal relationships to disclose that could inappropriately influence or bias our work.

#Corresponding author.

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