Temporal stage and grade migration in surgically treated patients with upper tract urothelial carcinoma.

UNLABELLED: Study Type - Therapy (individual cohort) Level of Evidence 2b

OBJECTIVE: To examine the temporal trends in stage and grade at presentation, as well as cancer-specific mortality (CSM) rates, in surgically treated patients with upper tract urothelial carcinoma (UTUC), as few population-based studies addressed contemporary cancer-control outcomes in patients with UTUC.

PATIENTS AND METHODS: Within the Surveillance, Epidemiology and End Results (SEER) database, we identified 4915 patients diagnosed with UTUC between 1983 and 2004, who had either a nephroureterectomy (NU) or a segmental ureterectomy (SU). Patients were divided into four groups according to the year-of-surgery quartiles. The chi-square test and the chi-square trend test were used for comparison of proportions and trends over time. Kaplan-Meier plots were used to graphically depict CSM rates. Multivariable Cox regression models were used to test the effect of the year-of-surgery quartiles on CSM. Covariates consisted of SEER stage, tumour grade, age, race, primary tumour site, type of surgery, and SEER registries.

RESULTS: Of 4915 assessable patients, 1316, 1328, 1146 and 1125 were, respectively, treated in 1983-1988, 1989-94, 1995-99 and 2000-2004. Of those, 4430 had a NU and 485 had a SU. The rates of non-localized stage and of grade III-IV disease at surgery increased, respectively, from 49.8% to 69.5% (P < 0.001) and 45.7 to 70.2% (P < 0.001) during the study period. CSM rates at 4 years after surgery reflected the temporal stage and grade differences, and increased from 18.2 to 23.9% (P = 0.03) between 1983-1988 and 2000-2004. In multivariable analyses, when stage and grade were taken into account, most contemporary patients showed more favourable CSM rates than their historic counterparts (hazard ratio 0.7, P = 0.02).

CONCLUSIONS: We report a stage and grade migration at NU or SU towards more aggressive disease among surgically treated patients between 1983 and 2004. Despite this observation, the CSM rates of contemporary patients have not worsened, which validates the role of NU and SU as effective treatments for UTUC.