Trends of incidence and prognosis of upper tract urothelial carcinoma

The purpose of this study was to investigate trends in the incidence of upper tract urothelial carcinoma (UTUC) in patients and to establish a reliable and practical nomogram based on significant clinical factors to predict the overall survival (OS) and cancer-specific survival (CSS) of UTUC patients. The Surveillance, Epidemiology, and End Results (SEER) database was used to extract data on UTUC patients between 1988 and 2015. Incidence was calculated using Joinpoint regression software, and trends were quantified by annual percentage change (APC). A nomogram was constructed using R software to predict the OS and CSS probabilities for individual patients. From 1988 to 2015, the incidence of UTUC showed a downward trend (1988: 1.57/100,000 to 2015: 1.51/100,000; APC=-0.1). After stratification according to sex, age and primary site, we found that the incidences of UTUC in males, patients 70+ years old and the renal pelvis were higher than those in females, patients <70 years old and ureter cancer patients. In the training cohort, the nomogram established based on multivariate Cox regression results showed better OS and CSS accuracy (OS: C-index=0.701, AUC=0.736; CSS: C-index=0.729, and AUC=0.688) than SEER stage. In addition, the calibration curves showed good consistency between the predicted and actual 3-, 5- and 10-year OS and CSS rates of the nomogram. In the past 30 years, the incidence of UTUC has shown a general downward trend, and the prognostic nomogram we established can provide a personalized risk assessment for the survival of UTUC patients.

Download Full-text

Trends of Incidence and Prognosis of Upper Tract Urothelial Carcinoma

10.21203/rs.3.rs-37927/v1 ◽

2020 ◽

Author(s):

Weipu Mao ◽

Zhipeng Xu ◽

Jian Li ◽

Weijun Chen ◽

Qingfang Kong ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Primary Site ◽

Upper Tract Urothelial Carcinoma ◽

Downward Trend ◽

R Software ◽

Cancer Specific Survival ◽

Upper Tract ◽

Good Consistency ◽

Personalized Risk Assessment ◽

Personalized Risk

Abstract Backgrud The purpose of this study was to investigate trends of incidence of upper tract urothelial carcinoma (UTUC) patients and establish reliable and practical nomogram based on significant clinical factors to predict the overall survival (OS) and cancer-specific survival (CSS) of UTUC patients.Methods The Surveillance, Epidemiology, and End Results (SEER) database extracts UTUC patients between 1988 and 2015. Incidence was calculated using joinpoint regression software, and trends were quantified by annual percentage change (APC). A nomogram was constructed using R software to predict the OS and CSS probabilities of a single patient. Results From 1988 to 2015, the incidence of UTUC showed a downward trend (1988: 1.57/100,000 to 2015: 1.51/100,000; APC=-0.1). After stratification according to sex, age and primary site, we found that the incidence of UTUC patients in male, 70+ years and renal pelvis were higher than those of female, <60 years,60-69 years and ureter UTUC patients. The nomogram based on age, sex, marital status, race, origin, primary site, histological type, grade, SEER stage, surgery, radiotherapy and chemotherapy variables showed good OS and CSS accuracy (OS: C-index=0.701, AUC=0.738; CSS: C-index=0.729, AUC=0.689). In addition, the calibration curves showed a good consistency between the predicted and actual 3-, 5- and 10-year OS and CSS rates of the nomogram.Conclusion In the past 30 years, the incidence of UTUC showed a general downward trend, and the prognostic nomogram we established can provide a personalized risk assessment for the survival of UTUC patients.

Download Full-text

Metabolic syndrome and upper tract urothelial carcinoma: A retrospective analysis from a large Chinese cohort.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.452 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 452-452

Author(s):

Hang Xu ◽

Ping Tan ◽

Lu Yang ◽

Qiang Wei

Keyword(s):

Metabolic Syndrome ◽

Urothelial Carcinoma ◽

Prediction Models ◽

Cox Regression ◽

Density Lipoprotein ◽

Upper Tract Urothelial Carcinoma ◽

Survival Outcomes ◽

Cancer Specific Survival ◽

Cox Regression Analysis ◽

Upper Tract

452 Background: Metabolic syndrome (MetS) has been reported to be associated with poor survival outcomes in cancer patients. However, the role of MetS in upper tract urothelial carcinoma (UTUC) has yet to be explored. We aim to investigate the prognostic value of MetS in UTUC after radical nephroureterectomy (RNU). Methods: A total of 644 patients with UTUC after RNU were identified at West China Hospital from May 2003 to December 2016. MetS was defined as the co-existence of three or more of five components (obesity, hypertension, elevated fasting glucose, decreased high-density lipoprotein-cholesterol and hypertriglyceridemia). Logistic and Cox regression analyses was performed to evaluate the associations of MetS with pathological features and survival outcomes. Decision curve analysis was performed to determine the clinical utility of the prediction models. Results: Of 644 patients, 157 (24.4%) had MetS. Over a median follow-up of 39 months, 269 (41.8%) experienced disease recurrence, 233 (36.2%) died and 185 (28.7%) died of UTUC. MetS was independently associated with high-grade disease (odds ratio [OR]: 2.01, P = 0.005), advanced pT stage (≥ pT3, OR: 1.54, P = 0.027) and lymphovascular invasion (OR: 1.71, P = 0.03). Multivariate Cox regression analysis showed that MetS was an independent factor for decreased cancer-specific survival (CSS, HR: 1.38, 95% CI: 1.01-1.89, P = 0.042) but not for RFS (HR: 1.27, 95% CI: 0.97-1.67, P = 0.078) and OS (HR: 1.24, 95% CI: 0.95-1.62, P = 0.121). The estimated c-index of the multivariate models for CSS was 0.763 compared with 0.769 when MetS added. Conclusions: MetS is a negative prognostic factor in UTUC. Further studies of MetS in UTUC are demanded.

Download Full-text

Marital status does not affect the cancer-specific survival of patients with upper tract urothelial carcinoma treated with nephroureterectomy: a propensity score matching study

Therapeutic Advances in Urology ◽

10.1177/1756287220981510 ◽

2020 ◽

Vol 12 ◽

pp. 175628722098151

Author(s):

Weipu Mao ◽

Jianping Wu ◽

Keyi Wang ◽

Bin Xu ◽

Ming Chen

Keyword(s):

Risk Factor ◽

Propensity Score ◽

Marital Status ◽

Urothelial Carcinoma ◽

Propensity Score Matching ◽

Independent Risk Factor ◽

Cox Regression ◽

Upper Tract Urothelial Carcinoma ◽

Cancer Specific Survival ◽

Upper Tract

Background: The purpose of this study was to investigate the relationship between marital status and the prognosis of patients with upper tract urothelial carcinoma (UTUC) treated with nephroureterectomy (NU). Methods: Patients with UTUC who received NU treatment were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. Kaplan–Meier curves and Cox regression were used to analyze the effect of marital status on cancer-specific survival (CSS), and 1:1 propensity score matching (PSM) was performed for married and unmarried patients to explore further the effect of marital status on patients with UTUC. Results: Among 1565 eligible patients, 960 (61.3%) were married and 605 (38.7%) were unmarried, of which 146 (9.3%) were divorced/separated, 306 (19.6%) were widowed, and 153 (9.8%) were single. Multivariate Cox regression analysis showed that marital status was not an independent risk factor for patients with UTUC treated with NU. After stratification by grade and SEER stage, multivariate analysis showed that there was no significant difference in 5-year CSS between divorced/separated, widowed, and single patients compared with married patients in different grades and SEER stages. In addition, after PSM analysis, marital status was still not an independent risk factor for patients with UTUC treated with NU. Conclusion: For patients with UTUC treated with NU, marital status has no prognostic effect on CSS.

Download Full-text

Developing a nomogram for predicting intravesical recurrence after radical nephroureterectomy: a retrospective cohort study of mainland Chinese patients

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyab017 ◽

2021 ◽

Author(s):

Shicong Lai ◽

Xingbo Long ◽

Pengjie Wu ◽

Jianyong Liu ◽

Samuel Seery ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Cox Regression ◽

Upper Tract Urothelial Carcinoma ◽

Chinese Patients ◽

Clinicopathological Parameters ◽

Radical Nephroureterectomy ◽

Ki 67 ◽

Data Set ◽

Mainland Chinese ◽

Upper Tract

Abstract Objective To evaluate the role of Ki-67 in predicting subsequent intravesical recurrence following radical nephroureterectomy and to develop a predictive nomogram for upper tract urothelial carcinoma patients. Methods This retrospective analysis involved 489 upper tract urothelial carcinoma patients who underwent radical nephroureterectomy with bladder cuff excision. The data set was randomly split into a training cohort of 293 patients and a validation cohort of 196 patients. Immunohistochemical analysis was used to assess the immunoreactivity of the biomarker Ki-67 in the tumor tissues. A multivariable Cox regression model was utilized to identify independent intravesical recurrence predictors after radical nephroureterectomy before constructing a nomographic model. Predictive accuracy was quantified using time-dependent receiver operating characteristic curve. Decision curve analysis was performed to evaluate the clinical benefit of models. Results With a median follow-up of 54 months, intravesical recurrence developed in 28.2% of this sample (n = 137). Tumor location, multifocality, pathological T stage, surgical approach, bladder cancer history and Ki-67 expression levels were independently associated with intravesical recurrence (all P < 0.05). The full model, which intercalated Ki-67 with traditional clinicopathological parameters, outperformed both the basic model and Xylinas’ model in terms of discriminative capacity (all P < 0.05). Decision-making analysis suggests that the more comprehensive model can also improve patients’ net benefit. Conclusions This new model, which intercalates the Ki-67 biomarker with traditional clinicopathological factors, appears to be more sensitive than nomograms previously tested across mainland Chinese populations. The findings suggest that Ki-67 could be useful for determining risk-stratified surveillance protocols following radical nephroureterectomy and in generating an individualized strategy based around intravesical recurrence predictions.

Download Full-text

MP78-07 GENDER-SPECIFIC DIFFERENCES IN CANCER-SPECIFIC SURVIVAL AFTER NEPHROURETERECTOMY WITH BLADDER CUFF FOR PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA

The Journal of Urology ◽

10.1016/j.juro.2017.02.2095 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Teruo Inamoto ◽

Kiyoshi Takahara ◽

Naokazu Ibuki ◽

Hideyasu Matsuyama ◽

Kiyohide Fujimoto ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Upper Tract Urothelial Carcinoma ◽

Cancer Specific Survival ◽

Upper Tract ◽

Gender Specific Differences ◽

Gender Specific

Download Full-text

Association of PD-L1 expression with cancer-specific survival in upper tract urothelial carcinoma

European Urology Supplements ◽

10.1016/s1569-9056(17)31208-3 ◽

2017 ◽

Vol 16 (3) ◽

pp. e2016

Author(s):

B. Zhang ◽

W. Yu ◽

X.-R. Feng ◽

Z. Zhao ◽

Y. Fan ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Upper Tract Urothelial Carcinoma ◽

Cancer Specific Survival ◽

Upper Tract

Download Full-text

576 Prediction of cancer-specific survival after radical nephroureterectomy for upper tract urothelial carcinoma: Development of an optimized post-operative nomogram using decision curve analysis

European Urology Supplements ◽

10.1016/s1569-9056(13)61059-3 ◽

2013 ◽

Vol 12 (1) ◽

pp. e576-e577

Author(s):

M. Rouprêt ◽

V. Hupertan ◽

T. Seisen ◽

P. Colin ◽

E. Xylinas ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Curve Analysis ◽

Upper Tract Urothelial Carcinoma ◽

Radical Nephroureterectomy ◽

Cancer Specific Survival ◽

Decision Curve Analysis ◽

Upper Tract

Download Full-text

Risk stratification by means of biological age-related factors better predicts cancer-specific survival than chronological age in patients with upper tract urothelial carcinoma: a multi-institutional database study

Therapeutic Advances in Urology ◽

10.1177/1756287218811050 ◽

2018 ◽

Vol 10 (12) ◽

pp. 403-410 ◽

Cited By ~ 4

Author(s):

Teruo Inamoto ◽

Hideyasu Matsuyama ◽

Naokazu Ibuki ◽

Kazumasa Komura ◽

Kiyohide Fujimoto ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Clinical Response ◽

Treatment Options ◽

Upper Tract Urothelial Carcinoma ◽

Biological Age ◽

Chronological Age ◽

Related Factors ◽

Cancer Specific Survival ◽

Upper Tract ◽

Age Related

Background: Chronological age is an important factor in determining the treatment options and clinical response of patients with upper tract urothelial carcinoma (UTUC). Much evidence suggests that chronological age alone is an inadequate indicator to predict the clinical response to radical nephroureterectomy (RNU). Patients and methods: We retrospectively reviewed the data from 1510 patients with UTUC (Ta-4) treated by surgery. White blood cell (WBC) count, neutrophil-to-lymphocyte ratio, hemoglobin (Hb), platelets, albumin, alkaline phosphatase, lactate dehydrogenase, creatinine, and corrected calcium were tested by the Spearman correlation to indicate the direction of association with chronological age, which yielded significant, negative associations of Hb ( p < 0.001) and WBC ( p = 0.010) with chronological age. For scoring, we assigned points for these categories as follows; point ‘0’ for Hb >14 (reference) and 13–13.9 [odds ratio (OR): 1.533], point ‘1’ for 12–12.9 (OR: 2.391), point ‘2’ for 11–11.9 (OR: 3.015), and point ‘3’ for <11 (OR: 3.584). For WBC, point ‘1’ was assigned for >9200 (OR: 2.541) and ‘0’ was assigned for the rest; 9200–8500 (reference), 8499–6000 (OR: 0.873), 5999–4500 (OR: 0.772), 4499–3200 (OR: 0.486), and <3200 (OR: 1.277). Results: The 10-year cancer-specific survival (CSS) in the higher risk group with scores of 4 or higher in patients age <60 years was worse than a score of 0, or 1 in age >80 years [mean estimated survival 69.7 months, confidence interval (CI): 33.3–106 versus 103.5. CI: 91–115.9]. The concordance index between biological age scoring and chronological age was 0.704 for CSS and 0.798 for recurrence-free survival. The limitation of the present study is the retrospective nature of the cohort included. Conclusions: The biological age scoring developed for patients with UTUC undergoing RNU. It was applicable to those with localized disease and performed well in diverse age populations.

Download Full-text

Oncological outcomes of neoadjuvant chemotherapy in patients with locally advanced upper tract urothelial carcinoma: A multicenter study.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.429 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 429-429

Author(s):

Shingo Hatakeyama ◽

Yuka Kubota ◽

Hayato Yamamoto ◽

Takahiro Yoneyama ◽

Yasuhiro Hashimoto ◽

...

Keyword(s):

Regression Analysis ◽

Neoadjuvant Chemotherapy ◽

Urothelial Carcinoma ◽

Lymphovascular Invasion ◽

Cox Regression ◽

Locally Advanced ◽

Upper Tract Urothelial Carcinoma ◽

Cancer Specific Survival ◽

Cox Regression Analysis ◽

Oncological Outcomes

429 Background: The clinical impact of neoadjuvant chemotherapy (NAC) on oncological outcomes in patients with locally advanced upper tract urothelial carcinoma (UTUC) remains unclear. We investigated the oncological outcomes of platinum-based NAC for locally advanced UTUC. Methods: A total of 426 patients who underwent radical nephroureterectomy at five medical centers between January 1995 and April 2017 were examined retrospectively. Of the 426 patients, 234 were treated for a high-risk disease (stages cT3–4 or locally advanced [cN+] disease) with or without NAC. NAC regimens were selected based on eligibility of cisplatin. We retrospectively evaluated post-therapy pathological downstaging, lymphovascular invasion, and prognosis stratified by NAC use. Multivariate Cox regression analysis was performed for independent factors for prognosis. Results: Of 234 patients, 101 received NAC (NAC group) and 133 did not (Control [Ctrl] group). The regimens in the NAC group included gemcitabine and carboplatin (75%), and gemcitabine and cisplatin (21%). Pathological downstagings of the primary tumor and lymphovascular invasion were significantly improved in the NAC than in the Ctrl groups. NAC for locally advanced UTUC significantly prolonged recurrence-free and cancer-specific survival. Multivariate Cox regression analysis using an inverse probability of treatment weighted (IPTW) method showed that NAC was selected as an independent predictor for prolonged recurrence-free and cancer-specific survival. However, the influence of NAC on overall survival was not statistically significant. Conclusions: Platinum-based NAC for locally advanced UTUC potentially improves oncological outcomes. Further prospective studies are needed to clarify the clinical benefit of NAC for locally advanced UTUC.

Download Full-text