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


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.
Raman
Jay D
JD
Division of Urology, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA. jraman@hmc.psu.edu
Messer
Jamie
J
Sielatycki
John A
JA
Hollenbeak
Christopher S
CS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000401:mortality*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000401:mortality*; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014516:Ureteral Neoplasms / Q000453:epidemiology / Q000401:mortality*; D055815:Young Adult