Incidence and survival of patients with carcinoma of the ureter and renal pelvis in the USA, 1973–2005

Abstract

Study Type – Prognosis (retrospective cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Upper‐tract urothelial carcinoma (UTUC) is a relatively uncommon urological malignancy with survival and outcomes data largely determined from single‐centre series which can be limited by relatively small case numbers. Through review of a large population based cohort, this study provides valuable information regarding epidemiological and survival patterns for over 13,000 patients with UTUC diagnosed over the past three decades. OBJECTIVE: • To evaluate epidemiological and survival patterns of upper‐tract urothelial carcinoma (UTUC) over the past 30 years through a review of a large, population‐based database. PATIENTS AND METHODS: • Data from the Surveillance, Epidemiology and End Results (SEER) database from 1973 to 2005 were reviewed in 10‐year increments to evaluate disease trends. • Univariate and multivariate survival analyses identified prognostic variables for outcomes. RESULTS: • In total, 13 800 SEER‐registered cases of UTUC were included. The overall incidence of UTUC increased from 1.88 to 2.06 cases per 100 000 person‐years during the period studied, with an associated increase in ureteral disease (0.69 to 0.91) and a decrease in renal pelvic cancers (1.19 to 1.15). • The proportion of in situ tumours increased from 7.2% to 31.0% ( P < 0.001), whereas local tumours declined from 50.4% to 23.6% ( P < 0.001). • There was no change in the proportion of patients presenting with distant disease. • In multivariate analysis, increasing patient age ( P < 0.001), male gender ( P < 0.001), black non‐Hispanic race ( P < 0.001), bilateral UTUC ( P = 0.001) and regional/distant disease ( P < 0.001) were all associated with poorer survival outcomes. CONCLUSIONS: • The incidence of UTUC has slowly risen over the past 30 years. • Increased use of bladder cancer surveillance regimens and improved abdominal cross‐sectional imaging may contribute to the observed stage migration towards more in situ lesions. • Although pathological disease characteristics impact cancer outcomes, certain sociodemographic factors also appear to portend worse prognosis.