Abstract
ObjectivesTo summarize the clinicopathological diagnostic features and evolutionary trends of upper tract urothelial carcinoma (UTUC) in China over the past 20 years.MethodsAll patients diagnosed with upper tract urothelial carcinoma in the Peking University First Hospital from 2001 to 2020 were retrospectively collected. Data were divided into two groups (2001-2010 and 2011-2020) according to the date of diagnosis. Statistical analysis was done with the SPSS V22.0. Chi-square analysis and t-test were adopted to analyze depending on the data type. Subgroup analysis based on 5 years was used for visualization to present trends. Both Kaplan-Meier curve and Cox regression were used for univariate and multivariate survival analysis.ResultsThe study included 2561 cases diagnosed with upper tract urothelial carcinoma in total. Compared with the first decade (2001-2010), patients of the second decades (2011-2020) had elder mean age (66.65 versus 67.59, years, p=0.025), higher male proportion (43.5% versus 49.0%, p=0.034), lower incidence of renal pelvic tumors (53.4% versus 45.8%, p<0.001) and multifocality (18.6% versus 12.0%, p<0.001), higher incidence of ureteral tumors (52.2% versus 60.9%, p<0.001).In recent ten years, the incidence of muscle-invasive urothelial carcinoma (pT2+) decreased significantly (64.4% versus 54.9%, p<0.001),and the mean size of renal pelvic tumors increased(3.46 versus 3.73, cm, p=0.043). The size of the ureteral tumor, the histopathologic grade showed no significant change. The prognostic analysis based on 709 patients regularly followed at our center revealed that the male gender and G3 histopathological grade were independent risk factors for poorer prognosis in patients with UTUC.ConclusionIn the past 20 years, the clinicopathological diagnostic features of upper tract urothelial carcinoma in the Chinese population has changed significantly, suggesting an increased risk of a poorer prognosis for UTUC. This trend may be related to updating diagnostic techniques and self-monitoring awareness. However, we need more high-grade, multicenter trials to verify it in the future.
Highlights
Upper tract urothelial carcinoma (UTUC) is an uncommon malignant disease that occurs in the pyelocaliceal cavity and ureter, accounting for only 5% to 10% of the urothelial carcinomas (UCs) [1]
Records of non-surgical treatments, and data with cytological pathology results only, 2561 cases of UTUC were recruited in this study
We found a significant decrease in the incidence of renal pelvic tumors, muscle-invasive and multifocal UTUC in the last 10 years, but the histological grading of the tumors remained unchanged, the incidence of the ureter and the size of the renal pelvic tumors showed an increasing trend
Summary
Upper tract urothelial carcinoma (UTUC) is an uncommon malignant disease that occurs in the pyelocaliceal cavity and ureter, accounting for only 5% to 10% of the urothelial carcinomas (UCs) [1]. UTUCs usually were multicentric and prone to recurrence, and have a higher grade and stage at diagnosis [2]. A recent study based on the SEER database showed that the incidence of UTUC in the United States gradually declined over the last 30 years and that the disease was significantly more prevalent in people over 70 years of age, in men, and renal pelvis [3]. Presumably due to the widespread application of aristolochic acid drugs, UTUC in the Chinese populations has different epidemiological characteristics from those of Western populations. Compared to Western people, the Chinese UTUC population has a higher tumor grade, relatively lower tumor stage, and lower malignancy in female patients compared to the males. There was no study on the trend of evolution of the pathological characteristics of the UTUC of the Chinese population in recent years
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