Che-Wei Chang1, Chien-Hui Ou2, Chih-Chin Yu3, Chi-Wen Lo3, Chung-You Tsai4, Pai-Yu Cheng4, Yung-Tai Chen5, Hsu-Che Huang6, Chia-Chang Wu7, Ching-Chia Li1, Hsiang-Ying Lee8. 1. Department of Urology, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan. 2. Department of Urology, National Cheng-Kung University Hospital, Tainan, Taiwan. 3. Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan. 4. Department of Urology, Far-Eastern Memorial Hospital, New Taipei City, Taiwan. 5. Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan. 6. Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan. 7. Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. 8. Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan. ashum1009@hotmail.com.
Abstract
BACKGROUND: A high incidence of upper urinary tract urothelial carcinoma has been reported in the southwestern area of Taiwan, where arsenic water contamination was considered the main cause. However, there is no definite proof to show a correlation between arsenic water contamination and upper urinary tract urothelial carcinoma. To investigate the clinical and epidemiological features of patients with upper urinary tract urothelial carcinoma between arsenic water endemic and non-endemic areas, we analyzed patients in terms of characteristics, stratified overall survival, disease-free survival, and cancer-specific survival. METHODS: The records of a total of 1194 patients diagnosed with upper urinary tract urothelial carcinoma were retrospectively reviewed. Clinical data and current medical status were collected from the medical records. Statistical analyses were performed to determine the clinical variables and stratified survival curves between endemic and non-endemic groups. RESULTS: Female predominance was revealed in both endemic and non-endemic groups (male:female ratio = 1:1.2-1.4). No statistical differences were found in histological types, staging, and tumor size between the two groups. Nonetheless, patients with characteristics of aging and having end-stage renal disease were outnumbered in the non-endemic group, while a higher prevalence of previous bladder tumors and more ureteral tumors were found in the endemic group. Adjusted stratified cumulative survival curves suggested a poorer prognosis in endemic patients, especially in disease-free survival of early stage disease. CONCLUSIONS: A higher mortality rate with more previous bladder cancer history and ureteral tumors was seen in patients with upper urinary tract urothelial carcinoma residing in the arsenic water contamination area. This may be attributed to the long-term carcinogenic effect of arsenic underground water.
BACKGROUND: A high incidence of upper urinary tract urothelial carcinoma has been reported in the southwestern area of Taiwan, where arsenicwater contamination was considered the main cause. However, there is no definite proof to show a correlation between arsenicwater contamination and upper urinary tract urothelial carcinoma. To investigate the clinical and epidemiological features of patients with upper urinary tract urothelial carcinoma between arsenicwater endemic and non-endemic areas, we analyzed patients in terms of characteristics, stratified overall survival, disease-free survival, and cancer-specific survival. METHODS: The records of a total of 1194 patients diagnosed with upper urinary tract urothelial carcinoma were retrospectively reviewed. Clinical data and current medical status were collected from the medical records. Statistical analyses were performed to determine the clinical variables and stratified survival curves between endemic and non-endemic groups. RESULTS: Female predominance was revealed in both endemic and non-endemic groups (male:female ratio = 1:1.2-1.4). No statistical differences were found in histological types, staging, and tumor size between the two groups. Nonetheless, patients with characteristics of aging and having end-stage renal disease were outnumbered in the non-endemic group, while a higher prevalence of previous bladder tumors and more ureteral tumors were found in the endemic group. Adjusted stratified cumulative survival curves suggested a poorer prognosis in endemic patients, especially in disease-free survival of early stage disease. CONCLUSIONS: A higher mortality rate with more previous bladder cancer history and ureteral tumors was seen in patients with upper urinary tract urothelial carcinoma residing in the arsenicwater contamination area. This may be attributed to the long-term carcinogenic effect of arsenic underground water.
Authors: Shahrokh F Shariat; Ricardo L Favaretto; Amit Gupta; Hans-Martin Fritsche; Kazumasa Matsumoto; Wassim Kassouf; Thomas J Walton; Stefan Tritschler; Shiro Baba; Kazuhito Matsushita; Patrick J Bastian; Juan I Martínez-Salamanca; Christian Seitz; Armin Pycha; Wolfgang Otto; Pierre I Karakiewicz; Vincenzo Ficarra; Giacomo Novara Journal: World J Urol Date: 2010-10-01 Impact factor: 4.226