Incidence and Survival Rates of Contemporary Patients with Invasive Upper Tract Urothelial Carcinoma

Abstract

Background: Contemporary incidence and mortality rates of upper tract urothelial carcinoma (UTUC) are unavailable.

Objective: To describe contemporary UTUC incidence and mortality rates in the USA.

Design, setting, and participants: Within the Surveillance, Epidemiology and End Results (SEER) database (2004-2016), we identified 13 075 UTUC patients. Of all, 9208 (70.4%) harbored nonmetastatic UTUC and were treated with radical nephroureterectomy versus 1174 (9.0%) who harbored metastatic UTUC.

Outcome measurements and statistical analysis: Age-standardized incidence rates per 100 000 person years were calculated. Kaplan-Meier curves and multivariable Cox regression models addressed cancer-specific and overall mortality.

Results and limitations: Overall UTUC age-standardized incidence rates decreased from 1.3 to 1.1 cases per 100 000 person years (average annual percentage change: -1.32%, p = 0.002). Moreover, age-standardized incidence rates decreased for T_1-2N₀M₀ (average annual percentage change: -2.77%, p < 0.001) but increased for T_1-4N_0-2M₁ stage (average annual percentage change: +2.87%, p < 0.01). In nonmetastatic UTUC treated with radical nephroureterectomy, stage, grade, age, and sex (p < 0.001) were independent predictors in multivariable Cox regression models focusing on cancer-specific mortality. In metastatic UTUC, chemotherapy administration, radical nephroureterectomy treatment, and ureteral primary were independent predictors of lower overall mortality in multivariable Cox regression models.

Conclusions: Although overall incidence of UTUC decreased, the incidence of metastatic UTUC increased over the study period. The majority of nonmetastatic UTUC harbored T₁N₀M₀ stage. However, T₃N₀M₀, T₄N₀M₀, and T_1-4N_1-2M₀ stages, respectively, affected 28.9%, 4.6%, and 10.0% of all incident cases. In metastatic UTUC, both chemotherapy and radical nephroureterectomy use exerted an important protective effect on overall mortality, and ureteral primaries exhibited more favorable survival.

Patient summary: From 2004 to 2016, the incidence of upper tract urothelial carcinoma decreased in the USA. However, more advanced stages are on the rise.

Keywords: Cancer-specific mortality; Radical nephroureterectomy; Surveillance, Epidemiology and End Results database; USA; Upper tract urothelial carcinoma.