title: Upper urinary tract urothelial carcinoma in eastern Taiwan: high proportion among all urothelial carcinomas and correlation with chronic kidney disease.
abstract: OBJECTIVE
  This study investigated the incidence of upper urinary tract urothelial carcinoma (UUT-UC) in eastern Taiwan and its association with chronic kidney disease (CKD).
  
  
  METHODS
  A total of 110 patients with histologically proven UUT-UC over a recent 20-year period were retrospectively analyzed to determine the clinical profile, overall survival and correlation with CKD.
  
  
  RESULTS
  The mean age at diagnosis was 68.7 +/- 9.8 years (range, 43-93 years), and the male to female ratio was 1 to 1.16 (51:59). The ratio of urothelial carcinoma (UC) of the renal pelvis to UC of the ureter to UC of the bladder was 1.2:1:6.7. UC of the renal pelvis accounted for 10.8% of all urinary tract UC, and for 41% of all renal cancer detected during the study period. The 2-, 5- and 10-year cancer-specific survival rates of patients with UUT-UC were 75%, 53.0% and 29%, respectively. Patients with high grade and high stage UUT-UC had significantly worse prognosis than those with low grade (p = 0.0047) and low stage (p = 0.0021). Of the 110 patients, 64 (58%) had impaired renal function (glomerular filtration rate < 60 mL/min/1.73 m2; defined as CKD), including 14 (13%) with end-stage renal disease (ESRD) before diagnosis. Patients with CKD or ESRD had significantly worse prognosis than those with normal renal function (p = 0.0399). High grade UC was found in 35 of 58 patients with CKD or ESRD (60%), which was significantly higher than in patients with normal renal function (12/26, 26%; p = 0.019).
  
  
  CONCLUSIONS
  A high proportion of UUT-UC was observed among all UCs and a significantly higher percentage of high grade UUT-UC (60%) were found in patients with CKD or ESRD in eastern Taiwan. These findings suggest that CKD and ESRD might play a role in the development of UC especially in the upper urinary tract.
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
authors.forename: Chia-Yen
authors.initials: CY
authors.lastname: Chen
authors.forename: Yung-Ming
authors.initials: YM
authors.lastname: Liao
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Tsai
authors.forename: Hann-Chorng
authors.initials: HC
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D007680:Kidney Neoplasms / Q000208:ethnology* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D007682:Kidney Pelvis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D014516:Ureteral Neoplasms / Q000208:ethnology / Q000209:etiology / Q000401:mortality / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000208:ethnology / Q000209:etiology / Q000401:mortality / Q000473:pathology; D014571:Urologic Neoplasms / Q000208:ethnology* / Q000209:etiology / Q000401:mortality / Q000473:pathology