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Tang X, Zhan X, Chen X. Incidence, mortality and survival of transitional cell carcinoma in the urinary system: A population-based analysis. Medicine (Baltimore) 2023; 102:e36063. [PMID: 37986351 PMCID: PMC10659715 DOI: 10.1097/md.0000000000036063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/06/2023] [Accepted: 10/20/2023] [Indexed: 11/22/2023] Open
Abstract
The goal of this study is exploring the disparity of incidence, mortality and survival outcome among transitional cell carcinomas (TCCs) in the 4 parts of urinary system. This study comprehensively evaluates these disparities using the Surveillance, Epidemiology, and End Results (SEER) (2000-2018) database. According to the SEER database, the urinary tract is divided into 4 parts: urinary bladder, renal pelvis, ureter, and urethra. The joinpoint regression was used to analyze the secular trend of incidence and incidence-based mortality (IBM). The Kaplan-Meier method with the log-rank test is performed to evaluate survival outcomes. The bladder TCC has the highest age-adjusted incidence and mortality rate compared with TCC in other 3 locations. A slight decrease in incidence is shown in the both bladder and urethra TCCs during 2000-2018. The age-adjusted mortality rate similarly presents an initial increase among 4 locations TCCs at the beginning of study period. The survival curves demonstrate that patients with bladder TCCs have better overall survival (OS) and cancer-specific survival (CSS), whereas those with renal pelvis TCCs have the worse OS and CSS. In addition, patients with bladder TCC have the highest 1-year, 3-year, 5-year relative survival rate, and those with renal pelvis TCC have the lowest. These disparities are especially essential when we explore tumor characteristics and treatment, extrapolated from the literature on bladder TCC for upper tract urothelial carcinoma (UTUC). Notably, patients with bladder TCC especially for localized stage have better survival outcomes than those with UTUC.
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Affiliation(s)
- Xiaofeng Tang
- Department of Urology, The First Hospital of Putian City, Putian, Fujian, China
| | - Xiangpeng Zhan
- Department of Urology, The First Hospital of Putian City, Putian, Fujian, China
| | - Xiaomin Chen
- Department of Cardiology, The Affiliated Hospital of Putian University, Putian, Fujian, China
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Tian C, Liu J, An L, Hong Y, Xu Q. Prognostic nomogram for overall survival in upper urinary tract urothelial carcinoma (UTUC) patients treated with chemotherapy: a SEER-based retrospective cohort study. BMC Urol 2023; 23:2. [PMID: 36609283 PMCID: PMC9825008 DOI: 10.1186/s12894-022-01172-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To establish a prognostic nomogram among UTUC patients who received chemotherapy. METHODS 1195 UTUC patients who received chemotherapy were extracted from the Surveillance, Epidemiology, and End Results (SEER) database for the period between 2004 and 2015. Patients were randomly divided into a training and a validation set. Nomogram was constructed to predict 1-, 3-, and 5-year overall survival (OS) in those patients. Receiver-operating characteristic curves (ROCs), calibration plots, and Decision curve analysis (DCA) were applied to assess and compare the discrimination, accuracy, and practicability of the nomogram with 8th American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging system. RESULTS Six clinical parameters were identified as independent prognostic factors for UTUC patients' OS, including age, marital status, TNM stage, and surgical methods of the primary site. The ROC curves showed a satisfactory discrimination capacity of the nomogram, with 1-, 3-, and 5-year area under curve (AUC) values of 0.789, 0.772, and 0.763 in the training set and 0.772, 0.822, and 0.814 in the validation set, respectively. Calibration curves indicated a good agreement between actual observation and nomogram prediction. ROC and DCA curves showed our nomograms exhibited larger benefits than the 8th AJCC-TNM staging system. CONCLUSIONS A prognostic nomogram was established and validated to present individual predictions of OS among chemotherapeutic UTUC patients. This nomogram may assist clinicians in accurate survival prognostication, treatment decision-making, and design of future clinical trials.
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Affiliation(s)
- Cong Tian
- grid.411634.50000 0004 0632 4559Department of Urology, Peking University People’s Hospital, Beijing, 100034 China ,grid.11135.370000 0001 2256 9319Peking University Applied Lithotripsy Institute, Peking University, 133# Fuchengmen Neidajie Street, XiCheng District, Beijing, 100034 China
| | - Jun Liu
- grid.411634.50000 0004 0632 4559Department of Urology, Peking University People’s Hospital, Beijing, 100034 China ,grid.11135.370000 0001 2256 9319Peking University Applied Lithotripsy Institute, Peking University, 133# Fuchengmen Neidajie Street, XiCheng District, Beijing, 100034 China
| | - Lizhe An
- grid.411634.50000 0004 0632 4559Department of Urology, Peking University People’s Hospital, Beijing, 100034 China ,grid.11135.370000 0001 2256 9319Peking University Applied Lithotripsy Institute, Peking University, 133# Fuchengmen Neidajie Street, XiCheng District, Beijing, 100034 China
| | - Yang Hong
- grid.411634.50000 0004 0632 4559Department of Urology, Peking University People’s Hospital, Beijing, 100034 China ,grid.11135.370000 0001 2256 9319Peking University Applied Lithotripsy Institute, Peking University, 133# Fuchengmen Neidajie Street, XiCheng District, Beijing, 100034 China
| | - Qingquan Xu
- grid.411634.50000 0004 0632 4559Department of Urology, Peking University People’s Hospital, Beijing, 100034 China ,grid.11135.370000 0001 2256 9319Peking University Applied Lithotripsy Institute, Peking University, 133# Fuchengmen Neidajie Street, XiCheng District, Beijing, 100034 China
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MicroRNA Signatures in the Upper Urinary Tract Urothelial Carcinoma Scenario: Ready for the Game Changer? Int J Mol Sci 2022; 23:ijms23052602. [PMID: 35269744 PMCID: PMC8910117 DOI: 10.3390/ijms23052602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 12/18/2022] Open
Abstract
Upper urinary tract urothelial carcinoma (UTUC) represents a minor subgroup of malignancies arising in the urothelium of the renal pelvis or ureter. The estimated annual incidence is around 2 cases per 100,000 people, with a mean age at diagnosis of 73 years. UTUC is more frequently diagnosed in an invasive or metastatic stage. However, even though the incidence of UTUC is not high, UTUC tends to be aggressive and rapidly progressing with a poor prognosis in some patients. A significant challenge in UTUC is ensuring accurate and timely diagnosis, which is complicated by the non-specific nature of symptoms seen at the onset of disease. Moreover, there is a lack of biomarkers capable of identifying the early presence of the malignancy and guide-tailored medical treatment. However, the growing understanding of the molecular biology underlying UTUC has led to the discovery of promising new biomarkers. Among these biomarkers, there is a class of small non-coding RNA biomarkers known as microRNAs (miRNAs) that are particularly promising. In this review, we will analyze the main characteristics of UTUC and focus on microRNAs as possible novel tools that could enter clinical practice in order to optimize the current diagnostic and prognostic algorithm.
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Hird AE, Magee DE, Cheung DC, Sander B, Sridhar S, Nam RK, Kulkarni GS. Neoadjuvant Versus Adjuvant Chemotherapy for Upper Tract Urothelial Carcinoma: A Microsimulation Model. Clin Genitourin Cancer 2020; 19:e135-e147. [PMID: 33168398 DOI: 10.1016/j.clgc.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/04/2020] [Accepted: 10/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Upper tract urothelial carcinoma (UTUC) is clinically understudied, and there are no definitive recommendations regarding timing of perioperative chemotherapy. The objective of this study was to compare 3 treatment pathways in UTUC: nephroureterectomy (NU) alone, neoadjuvant chemotherapy (NAC), and adjuvant chemotherapy (AC) using a microsimulation model. PATIENTS AND METHODS An individual-level state transition model was constructed using TreeAgePro software to compare treatment strategies for patients with newly diagnosed UTUC. The base case was that of a 70-year-old patient with a radiographically localized upper tract tumor. Primary outcome was quality-adjusted life expectancy. Secondary outcomes included crude overall survival, rates of adverse events, and bladder cancer diagnoses. RESULTS A total of 100,000 patients were simulated. NAC was preferred, with an estimated quality-adjusted life expectancy of 7.50 years versus 6.79 years with NU alone and 7.23 years with AC. Median crude overall survival was 123 months with NAC, 96 months with NU only, and 111 months with AC. Overall, 40.0% of patients in the AC group with invasive pathology completed chemotherapy. In the NAC group, 83.3% of patients completed chemotherapy. In the NAC group, 37.5% of patients experienced an adverse chemotherapy event compared to 15.1% of patients in the AC group. Bladder cancer recurrence rates were 64.9%, 65.9%, and 67.4% over the patient's lifetime for the NU, NAC, and AC strategies, respectively. CONCLUSION This study supports the increased use of NAC in UTUC until robust randomized trials are completed. The ultimate choice should be based on patient and tumor factors.
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Affiliation(s)
- Amanda E Hird
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Diana E Magee
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Douglas C Cheung
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Srikala Sridhar
- Division of Medical Oncology and Hematology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert K Nam
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update. Eur Urol 2020; 79:62-79. [PMID: 32593530 DOI: 10.1016/j.eururo.2020.05.042] [Citation(s) in RCA: 473] [Impact Index Per Article: 118.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Panel on Upper Urinary Tract Urothelial Carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the current evidence-based management of UTUC and to incorporate recommendations into clinical practice. OBJECTIVE To provide an overview of the EAU guidelines on UTUC as an aid to clinicians. EVIDENCE ACQUISITION The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified following a systematic search of Medline. Data on urothelial malignancies and UTUC were searched using the following keywords: urinary tract cancer, urothelial carcinomas, upper urinary tract carcinoma, renal pelvis, ureter, bladder cancer, chemotherapy, ureteroscopy, nephroureterectomy, neoplasm, adjuvant treatment, instillation, recurrence, risk factors, and survival. References were weighted by a panel of experts. EVIDENCE SYNTHESIS Owing to the rarity of UTUC, there are insufficient data to provide strong recommendations. The 2017 tumour, node, metastasis (TNM) classification is recommended. Recommendations are given for diagnosis and risk stratification as well as for radical and conservative treatment, and prognostic factors are discussed. A single postoperative dose of intravesical mitomycin after nephroureterectomy reduces the risk of bladder tumour recurrence. Kidney-sparing management should be offered as a primary treatment option to patients with low-risk tumour and two functional kidneys. After radical nephroureterectomy, cisplatin-based chemotherapy is indicated in locally advanced UTUC. CONCLUSIONS These guidelines contain information on the management of individual patients according to a current standardised approach. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen, based on the proposed risk stratification of these tumours. PATIENT SUMMARY Urothelial carcinoma of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, an appropriate diagnosis is most important. A number of known risk factors exist.
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Pape L, Richter J, Dunst J. [Adjuvant chemotherapy in the treatment of urothelial carcinoma of the upper urinary tract]. Strahlenther Onkol 2020; 196:837-840. [PMID: 32561938 DOI: 10.1007/s00066-020-01640-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Feldstr. 21, 24105, Kiel, Deutschland.
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Affiliation(s)
- Simon J Crabb
- Cancer Sciences Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
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Hwang EC, Sathianathen NJ, Jung JH, Kim MH, Narayan V, Hwang JE, Spiess PE, Dahm P. Perioperative systemic chemo-immunotherapy for upper urinary tract urothelial carcinoma. Hippokratia 2020. [DOI: 10.1002/14651858.cd013567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eu Chang Hwang
- Chonnam National University Medical School, Chonnam National University Hwasun Hospital; Department of Urology; Hwasun Korea, South
| | | | - Jae Hung Jung
- Yonsei University Wonju College of Medicine; Department of Urology; 20 Ilsan-ro Wonju Gangwon Korea, South 26426
| | - Myung Ha Kim
- Yonsei University Wonju College of Medicine; Yonsei Wonju Medical Library; Wonju Korea, South
| | - Vikram Narayan
- University of Minnesota; Department of Urology; Minneapolis Minnesota USA
| | - Jun Eul Hwang
- Chonnam National University Medical School, Chonnam National University Hwasun Hospital; Department of Hematology-Oncology; Hwasun Korea, South
| | | | - Philipp Dahm
- Minneapolis VA Health Care System; Urology Section; One Veterans Drive Mail Code 112D Minneapolis Minnesota USA 55417
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Zhang GL, Zhou W. A Model for the Prediction of Survival in Patients With Upper Tract Urothelial Carcinoma After Surgery. Dose Response 2019; 17:1559325819882872. [PMID: 31662711 PMCID: PMC6794662 DOI: 10.1177/1559325819882872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 12/29/2022] Open
Abstract
Objective: We aimed to formulate and validate prognostic nomograms that can be used to
predict the prognosis of patients with upper tract urothelial carcinoma
(UTUC). Methods: By consulting the Surveillance, Epidemiology, and End Results (SEER)
database, we identified patients who were surgically treated for UTUC
between 2004 and 2013. Variables were analyzed in both univariate and
multivariate analyses. Nomograms were constructed based on independent
prognostic factors. The prognostic nomogram models were established and
validated internally and externally to determine their ability to predict
the survival of patients with UTUC. Results: A total of 4990 patients were collected and enrolled in our analyses. Of
these, 3327 patients were assigned to the training set and 1663 to the
validation set. Nomograms were effectively applied to predict the 3- and
5-year survivals of patients with UTUC after surgery. The nomograms
exhibited better accuracy for predicting overall survival (OS) and
cancer-specific survival (CSS) than the tumor-node-metastasis (TNM) staging
system and the SEER stage in both the training and validation sets.
Calibration curves indicated that the nomograms exhibited high correlation
to actual observed results for both OS and CSS. Conclusions: The nomogram models showed stronger predictive ability than the TNM staging
system and the SEER stage. Precise estimates of the prognosis of UTUC might
help doctors to make better treatment decisions.
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Affiliation(s)
- Guang-Lin Zhang
- Department of Abdominal and Pelvic Medical Oncology II ward, Huangshi Central Hospital (Pu Ai Hospital), Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, Hubei, People's Republic of China
| | - Wei Zhou
- Department of Urology, Huangshi Central Hospital (Pu Ai Hospital), Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, Hubei, People's Republic of China
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