MO497: Upper Tract Urothelial Cancer and Balkan Endemic Nephropathy: 65 Years of Follow UP

Abstract

Abstract BACKGROUND AND AIMS All researchers dealing with Balkan endemic nephropathy (BEN) talk about the association of BEN with malignant tumours of the upper urothelium (UTUC). Long-term research of UTUC obtained various results depending on the period and region of observation, depending on the stage of renal failure, degree of malignancy, surgical or autopsy treatment. The aim of this paper is to monitor UTUC in certain parts of the Republic of Serbia in a long period of time and what is the frequency of tumours in relation to the observed endemic and non-endemic built-up areas for BEN. METHOD Occurrence of UTUC was analyzed for the period 1953–2017 on the basis of operational protocols of the Institute of Urology and Nephrology KCS Belgrade, Clinic of Urology Nis, Department of Urology and Haemodialysis Leskovac. The categorization of built-up areas into (A) endemic, (B) hypoendemic, (C) non-endemic rural and (D) non-endemic urban built-up areas was used. For practical reasons, the groups of built-up areas (A) and (B) united in the group of endemic and (C) and (D) in the group of non-endemic built-up areas. The average annual incidence rate (AAIR) is calculated/100 000 inhabitants. RESULTS In his summary series of UTUC, which included a large number of urological centres in Serbia, Petkovic found in a period of 20 years (1953–1973) that the frequency of tumours is 100 times higher in an endemic than in a non-endemic built-up area. In a 40-year study (1978–2017), Glogovac found that the incidence of tumours in Jablanica district was 14.24 times higher in endemic (AAIR-11.82) than in non-endemic built-up areas (AAIR-0.83) in the last 20 years (1998–2017). The frequency is 4.14 times higher. The linear trend of UTUC in the Jablanica district in the endemic built-up area for BEN in the observed 40-year period was in a statistically weak decline (y = –0.0276x + 55.691; r2 = 0.1718) while for BEN it was in a statistically significant decline (y = –0.2127x + 6.6966; r2 = 0.8529). CONCLUSION The high frequency of UTUC in regions with BEN may indicate a common nephropathogenic and carcinogenic etiological factor and confirms the existence of a positive correlation between BEN and UTUC. The reason for the decline in the frequency of UTUC in the observed built-up area in the observed period should be sought in the drastic decline in BEN, which is explained by changes in the course of the disease, better screening, water supply, health education, lower toxicity, micromigration and possibly misdiagnosis.