Upper Urothelial Tumors in Emigrants from Balkan Endemic Nephropathy Areas in Serbia

Abstract

Aim: The aim of the study was to investigate upper urothelial tumors (UUT) in emigrants from Balkan endemic nephropathy (BEN) areas in Serbia and compare them with UUT from both endemic and nonendemic areas. Materials and Methods: A total of 1,121 patients from the state cancer database, between 1960 and 1998, were investigated. Sixty of them were emigrants from BEN areas. Results: UUT in emigrants from BEN areas occurred after 21.7 ± 9.9 years (median 20) spent in a rural environment. The time spent outside of the BEN regions was 33.2 ± 12.8 years (median 31, range 10–72). Age at surgery was 55 years (range 31–89). In emigrants from BEN areas, there was a significant association of other diseases with UUT: renal failure in 63%, bladder tumors in 23.3% and bilateralism in 6.7% of the patients. Bilateralism was statistically more frequent in emigrants from BEN areas (p = 0.04), as were low-grade tumors (p = 0.03). There was no statistical difference in tumor stage between patients from BEN areas and from outside of them. Relatives of the emigrants from BEN areas were also affected by BEN, UUT and both of them (33%). Conclusions: It is concluded that hereditary as well as environmental factors are important for the expression and evolution of the disease. An early period of life spent in the endemic region seems important for the later development of UUT in emigrants from BEN regions. Different time spans spent in the endemic region have no effect on the age of appearance of UUT.