Brendan M Browne1, Kristian D Stensland2, Matthew J Moynihan2, David Canes2. 1. Department of Urology, Lahey Hospital and Medical Center, Burlington, MA. Electronic address: brendan.m.browne@gmail.com. 2. Department of Urology, Lahey Hospital and Medical Center, Burlington, MA.
Abstract
BACKGROUND: The purpose of this study was to analyze contemporary trends for diagnosis and treatment of upper tract urothelial carcinoma (UTUC). PATIENTS AND METHODS: We identified all cases of UTUC in the National Cancer Database (NCDB) between 2004 and 2013. Data comprising tumor, patient, and facility factors were extracted. Treatment data for surgery and chemotherapy were also collected. Comparisons used χ2 testing. RESULTS: Over this 10-year period, the sex and age distribution of UTUC was stable at 60% male and median age of 72 years. Most tumors were < cT2 at diagnosis, with an upward trend over 10 years (66% to 72%; P < .001). However, presentation with clinical metastatic disease also rose, from 4.6% to 8.9% (P < .001). Primary tumor biopsy increased from 37% to 50%. Overall rate of nephroureterectomy decreased from 59.6% to 56.7% whereas endoscopic ablation increased from 9.8% to 11.5%. Ablation was much more common in < cT2 tumors than ≥ cT2 (18.3% vs. 3.7%) and for low-grade tumors than high-grade (22.6% vs. 5.9%). Neoadjuvant chemotherapy was significantly more used, but still at a low rate. CONCLUSION: Treatment of UTUC appears to be shifting toward conservative surgical management with tumor ablation, and increasing neoadjuvant chemotherapy use. More primary tumor biopsies are being performed, likely reflecting improved ureteroscopic instruments and training. The NCDB also reports an increase in metastatic disease, which must be interpreted cautiously and might be artifactual.
BACKGROUND: The purpose of this study was to analyze contemporary trends for diagnosis and treatment of upper tract urothelial carcinoma (UTUC). PATIENTS AND METHODS: We identified all cases of UTUC in the National Cancer Database (NCDB) between 2004 and 2013. Data comprising tumor, patient, and facility factors were extracted. Treatment data for surgery and chemotherapy were also collected. Comparisons used χ2 testing. RESULTS: Over this 10-year period, the sex and age distribution of UTUC was stable at 60% male and median age of 72 years. Most tumors were < cT2 at diagnosis, with an upward trend over 10 years (66% to 72%; P < .001). However, presentation with clinical metastatic disease also rose, from 4.6% to 8.9% (P < .001). Primary tumor biopsy increased from 37% to 50%. Overall rate of nephroureterectomy decreased from 59.6% to 56.7% whereas endoscopic ablation increased from 9.8% to 11.5%. Ablation was much more common in < cT2tumors than ≥ cT2 (18.3% vs. 3.7%) and for low-grade tumors than high-grade (22.6% vs. 5.9%). Neoadjuvant chemotherapy was significantly more used, but still at a low rate. CONCLUSION: Treatment of UTUC appears to be shifting toward conservative surgical management with tumor ablation, and increasing neoadjuvant chemotherapy use. More primary tumor biopsies are being performed, likely reflecting improved ureteroscopic instruments and training. The NCDB also reports an increase in metastatic disease, which must be interpreted cautiously and might be artifactual.
Authors: Ahmad Shabsigh; Nir Kleinmann; Angela B Smith; Douglas Scherr; Elyse Seltzer; Mark Schoenberg; Seth P Lerner Journal: Cancer Chemother Pharmacol Date: 2021-03-07 Impact factor: 3.333
Authors: Jeremy Ng Chieng Hin; Dinul Hettiarachchilage; Paul Gravestock; Bhavan Rai; Bhaskar K Somani; Rajan Veeratterapillay Journal: Curr Urol Rep Date: 2021-10-07 Impact factor: 3.092
Authors: Claudia Collà Ruvolo; Christoph Würnschimmel; Mike Wenzel; Luigi Nocera; Giuseppe Celentano; Francesco Mangiapia; Zhe Tian; Shahrokh F Shariat; Fred Saad; Felix H C Chun; Alberto Briganti; Nicola Longo; Vincenzo Mirone; Pierre I Karakiewicz Journal: Int J Clin Oncol Date: 2021-06-06 Impact factor: 3.402