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Keywords:

  • transitional cell carcinoma;
  • urothelial carcinoma;
  • renal pelvis;
  • ureter;
  • survival;
  • outcomes

Study Type – Prognosis (retrospective cohort) Level of Evidence 2b

What’s known on the subject? and What does the study add?

Upper-tract urothelial carcinoma (UTUC) is a relatively uncommon urological malignancy with survival and outcomes data largely determined from single-centre series which can be limited by relatively small case numbers.

Through review of a large population based cohort, this study provides valuable information regarding epidemiological and survival patterns for over 13,000 patients with UTUC diagnosed over the past three decades.

OBJECTIVE

• To evaluate epidemiological and survival patterns of upper-tract urothelial carcinoma (UTUC) over the past 30 years through a review of a large, population-based database.

PATIENTS AND METHODS

• Data from the Surveillance, Epidemiology and End Results (SEER) database from 1973 to 2005 were reviewed in 10-year increments to evaluate disease trends.

• Univariate and multivariate survival analyses identified prognostic variables for outcomes.

RESULTS

• In total, 13 800 SEER-registered cases of UTUC were included. The overall incidence of UTUC increased from 1.88 to 2.06 cases per 100 000 person-years during the period studied, with an associated increase in ureteral disease (0.69 to 0.91) and a decrease in renal pelvic cancers (1.19 to 1.15).

• The proportion of in situ tumours increased from 7.2% to 31.0% (P < 0.001), whereas local tumours declined from 50.4% to 23.6% (P < 0.001).

• There was no change in the proportion of patients presenting with distant disease.

• In multivariate analysis, increasing patient age (P < 0.001), male gender (P < 0.001), black non-Hispanic race (P < 0.001), bilateral UTUC (P= 0.001) and regional/distant disease (P < 0.001) were all associated with poorer survival outcomes.

CONCLUSIONS

• The incidence of UTUC has slowly risen over the past 30 years.

• Increased use of bladder cancer surveillance regimens and improved abdominal cross-sectional imaging may contribute to the observed stage migration towards more in situ lesions.

• Although pathological disease characteristics impact cancer outcomes, certain sociodemographic factors also appear to portend worse prognosis.