Christopher Wang

Introduction Understanding performance status (PS) is an essential aspect of oncologic care. PS is traditionally evaluated using the Karnofsky Performance Status (KPS) or Eastern Cooperative Oncology Group (ECOG) performance scales. Despite their ubiquity, these tools rely on subjective clinician interpretation and broad clinical categories, which contribute to poor inter-rater reliability and imprecise patient characterization. This study explores digital approaches to PS by leveraging three-dimensional video recordings and kinematic movement data to provide more objective, granular evaluations. Methods In this single-center observational study, 34 oncology patients performed a standardized chair-to-table (CTT) movement. Of these participants, 52.9% were male and 47.1% were female. Patient movement was recorded using the Microsoft Kinect v2 sensor, which captures both color video (RGB) and depth-based skeletal tracking (Skeleton). Four oncologists independently reviewed the recordings and assigned KPS scores. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). Pelvic acceleration metrics extracted from the Kinect data were correlated with summed KPS scores using Spearman’s rank correlation. Results The ICC for KPS scoring was 0.844 for RGB and 0.790 for Skeleton recordings, indicating good inter-rater reliability despite notable inter-observer variability. Vertical pelvic acceleration (mean and median) strongly correlated with summed KPS scores in both RGB (ρ ≈ 0.73–0.75, p < 0.0001) and Skeleton recordings (ρ ≈ 0.69–0.72, p < 0.0001). Horizontal and maximum acceleration showed weaker or nonsignificant associations. Conclusion Kinect-derived motion capture offers an objective and reproducible approach to characterizing a patient’s PS. Strong correlations between vertical pelvic acceleration and clinician-assigned KPS scores support its potential to augment both the accuracy and granularity of PS evaluation. Trial Registry ClinicalTrials.gov ID: NCT07082257.

Background/Objectives: Upper tract urothelial carcinoma (UTUC) is a rare and biologically distinct subset of urothelial malignancies, comprising approximately 5–10% of urothelial cancers. UTUC presents unique diagnostic and therapeutic challenges, with both a higher likelihood of invasive disease at presentation and a less favorable prognosis compared to urothelial carcinoma of the bladder. Current treatment strategies for UTUC are largely derived from bladder cancer studies, underscoring the need for UTUC-directed research. This review provides a comprehensive overview of UTUC, encompassing diagnostic approaches, systemic and intraluminal therapies, surgical management, and future directions. Methods: A narrative review was conducted synthesizing evidence from guideline-based recommendations, retrospective and prospective clinical studies, and ongoing trials focused on UTUC. Results: Neoadjuvant cisplatin-based chemotherapy is increasingly preferred in UTUC due to the risk of postoperative renal impairment that may preclude adjuvant cisplatin use. Surgical management includes kidney-sparing approaches and radical nephroureterectomy (RNU), with selection guided by tumor risk and patient comorbidities. While endoscopic management (EM) preserves renal function, it carries a higher recurrence and surveillance burden; RNU remains standard for high-risk cases. Systemic therapy for advanced and metastatic UTUC mirrors that of bladder urothelial carcinoma. Enfortumab vedotin (EV) plus pembrolizumab showed superior efficacy over chemotherapy in the EV-302 trial, with improved response rate, progression-free survival, and overall survival across subgroups, including UTUC. For patients ineligible for EV, the CheckMate-901 study supported first-line chemoimmunotherapy with gemcitabine, cisplatin, and nivolumab. Further systemic therapy strategies include maintenance avelumab post-chemotherapy (JAVELIN Bladder 100), targeted therapies such as erdafitinib (THOR trial), and trastuzumab deruxtecan (DESTINY-PanTumor02) in FGFR2/3-altered and HER2-positive disease, respectively. Conclusions: Historically, the therapeutic landscape of UTUC has been extrapolated from bladder cancer; however, ongoing research specific to UTUC is deriving more precise regimens involving the use of immune checkpoint inhibitors, antibody–drug conjugates, and biomarker-driven therapies.