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

Abstract

BackgroundContemporary incidence and mortality rates of upper tract urothelial carcinoma (UTUC) are unavailable. ObjectiveTo describe contemporary UTUC incidence and mortality rates in the USA. Design, setting, and participantsWithin 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 analysisAge-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 limitationsOverall 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 T1–2N0M0 (average annual percentage change: –2.77%, p < 0.001) but increased for T1–4N0–2M1 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. ConclusionsAlthough 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 T1–4N1–2M0 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 summaryFrom 2004 to 2016, the incidence of upper tract urothelial carcinoma decreased in the USA. However, more advanced stages are on the rise.