A Multi-Institutional Comparison of Clinicopathological Characteristics and Oncologic Outcomes of Upper Tract Urothelial Carcinoma in China and the United States

No AccessJournal of UrologyAdult Urology1 May 2017A Multi-Institutional Comparison of Clinicopathological Characteristics and Oncologic Outcomes of Upper Tract Urothelial Carcinoma in China and the United States Nirmish Singla, Dong Fang, Xiaohong Su, Zhengqing Bao, Zhenpeng Cao, Syed M. Jafri, Gengyan Xiong, Lei Zhang, Ryan Hutchinson, Arthur Sagalowsky, Yair Lotan, Xuesong Li, Liqun Zhou, Jay D. Raman, and Vitaly Margulis Nirmish SinglaNirmish Singla Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author , Dong FangDong Fang Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author , Xiaohong SuXiaohong Su Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author , Zhengqing BaoZhengqing Bao Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author , Zhenpeng CaoZhenpeng Cao Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author , Syed M. JafriSyed M. Jafri Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania More articles by this author , Gengyan XiongGengyan Xiong Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author , Lei ZhangLei Zhang Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author , Ryan HutchinsonRyan Hutchinson Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author , Arthur SagalowskyArthur Sagalowsky Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author , Yair LotanYair Lotan Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author , Xuesong LiXuesong Li Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author , Liqun ZhouLiqun Zhou Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author , Jay D. RamanJay D. Raman Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania More articles by this author , and Vitaly MargulisVitaly Margulis Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.11.094AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated differences in clinicopathological characteristics and oncologic outcomes between patients with upper tract urothelial carcinoma in mainland China and the United States. Materials and Methods: We retrospectively compiled clinicopathological and oncologic outcomes data on patients with upper tract urothelial carcinoma treated surgically at tertiary care medical facilities in the United States or China from 1998 to 2015. Baseline demographics, comorbidities and pathological features were evaluated. Oncologic end points, including intravesical recurrence and cancer specific survival, were obtained after excluding patients who received systemic chemotherapy. Multivariable Cox regression was performed to determine predictors of adverse oncologic outcomes for each country. Results: A total of 775 patients with upper tract urothelial carcinoma were identified, including 451 in China and 324 in the United States. Median followup was 42 months. American patients were more frequently male (65% vs 44%) and smokers (79% vs 18%), and had a worse mean ASA® (American Society of Anesthesiologists®) score (2.7 vs 2.2) and prior bladder cancer (41% vs 4%, all p <0.001). Chinese patients more often had preoperative hydronephrosis (56% vs 40%), high grade pathology (98% vs 77%), muscle invasion (64% vs 38%) and nodal metastases (26% vs 6%, all p <0.001). American patients had worse overall survival on Kaplan-Meier analysis (p = 0.049). However, country of origin did not predict local relapse or cancer specific survival. Conclusions: Patient and disease characteristics of upper tract urothelial carcinoma differed between the Chinese and American cohorts. Chinese patients appeared relatively healthier at presentation but more often exhibited adverse pathological features. While evaluation and management patterns may account for these variations, the pathological findings may reflect a differential underlying pathogenesis of disease. Additional study is warranted to further characterize these differences. References 1 : European Association of Urology guidelines on upper urinary tract urothelial cell carcinoma: 2015 update. Eur Urol2015; 68: 868. Google Scholar 2 : A proportion of hereditary upper urinary tract urothelial carcinomas are misclassified as sporadic according to a multi-institutional database analysis: proposal of patient-specific risk identification tool. BJU Int2012; 110: E583. Google Scholar 3 : Predictive factors for worse pathological outcomes of upper tract urothelial carcinoma: experience from a nationwide high-volume centre in China. BJU Int2013; 112: 917. Google Scholar 4 : Ureteroscopic and extirpative treatment of upper urinary tract urothelial carcinoma: a 15-year comprehensive review of 160 consecutive patients. BJU Int2012; 110: 1618. Google Scholar 5 : Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology1998; 52: 594. Crossref, Medline, Google Scholar 6 : Bilateral metachronous ureteral and renal pelvic carcinomas: incidence, clinical presentation, histopathology, treatment and outcome. J Urol2006; 175: 69. Link, Google Scholar 7 : Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer2009; 115: 1224. Google Scholar 8 : Gender differences in radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol2011; 29: 481. Google Scholar 9 : Location of the primary tumor is not an independent predictor of cancer specific mortality in patients with upper urinary tract urothelial carcinoma. J Urol2009; 182: 2177. Link, Google Scholar 10 : Nephroureterectomy and segmental ureterectomy in the treatment of invasive upper tract urothelial carcinoma: a population-based study of 2299 patients. Eur J Cancer2009; 45: 3291. Google Scholar 11 : Gender-related differences in patients with stage I to III upper tract urothelial carcinoma: results from the Surveillance, Epidemiology, and End Results database. Urology2010; 75: 321. Google Scholar 12 : Gender differences in stage distribution of bladder cancer. Urology2000; 55: 368. Google Scholar 13 : Aristolochic acid-associated urothelial cancer in Taiwan. Proc Natl Acad Sci U S A2012; 109: 8241. Google Scholar 14 : Unusual clinical presentation of upper urothelial carcinoma in Taiwan. Cancer1999; 85: 1342. Google Scholar 15 : Environmental factors involved in carcinogenesis of urothelial cell carcinomas of the upper urinary tract. BJU Int2009; 104: 1436. Google Scholar 16 : Unusually high incidence of upper urinary tract urothelial carcinoma in Taiwan. Urology2002; 59: 681. Google Scholar 17 : Incidence, characteristics, treatment strategies, and oncologic outcomes of synchronous bilateral upper tract urothelial carcinoma in the Chinese population. Urol Oncol2015; 33: 66.e1. Google Scholar 18 : Significant predictive factors for prognosis of primary upper urinary tract cancer after radical nephroureterectomy in Taiwanese patients. Eur Urol2008; 54: 1127. Google Scholar 19 : Diagnostic ureteroscopy independently correlates with intravesical recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. Ann Surg Oncol2013; 20: 3121. Google Scholar 20 : Gender-related differences in pathological characteristics of upper urinary tract urothelial carcinoma: analysis of 597 cases. Beijing Da Xue Xue Bao2011; 43: 522. Google Scholar 21 : AJCC Cancer Staging Manual, 7th ed. New York: Springer2010. Google Scholar 22 : The World Health Organization/International Society of Urological Pathology consensus classification of urothelial (transitional cell) neoplasms of the urinary bladder. Bladder Consensus Conference Committee. Am J Surg Pathol1998; 22: 1435. Crossref, Medline, Google Scholar 23 : Preoperative hydronephrosis, ureteroscopic biopsy grade and urinary cytology can improve prediction of advanced upper tract urothelial carcinoma. J Urol2010; 184: 69. Link, Google Scholar 24 : Grade of hydronephrosis and tumor diameter as preoperative prognostic factors in ureteral transitional cell carcinoma. Urology2007; 70: 662. Google Scholar 25 : Degree of hydronephrosis predicts adverse pathological features and worse oncologic outcomes in patients with high-grade urothelial carcinoma of the upper urinary tract. Urol Oncol2014; 32: 981. Google Scholar 26 : Multi-institutional validation of the ability of preoperative hydronephrosis to predict advanced pathologic tumor stage in upper-tract urothelial carcinoma. Urol Oncol2013; 31: 904. Google Scholar 27 : Does the presence of hydronephrosis on preoperative axial CT imaging predict worse outcomes for patients undergoing nephroureterectomy for upper-tract urothelial carcinoma?. Urol Oncol2011; 29: 27. Google Scholar 28 : Presence of concomitant non-muscle-invasive bladder cancer in Chinese patients with upper tract urothelial carcinoma: risk factors, characteristics, and predictive value. Ann Surg Oncol2015; 22: 2789. Google Scholar 29 : Aristolochic acid and the etiology of endemic (Balkan) nephropathy. Proc Natl Acad Sci U S A2007; 104: 12129. Google Scholar 30 : Biotransformation enzymes in development of renal injury and urothelial cancer caused by aristolochic acid. Kidney Int2008; 73: 1209. Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySountoulides P, Pyrgidis N, Brookman-May S, Mykoniatis I, Karasavvidis T and Hatzichristou D (2020) Does Ureteral Stenting Increase the Risk of Metachronous Upper Tract Urothelial Carcinoma in Patients with Bladder Tumors? A Systematic Review and Meta-analysisJournal of Urology, VOL. 205, NO. 4, (956-966), Online publication date: 1-Apr-2021.Laguna M (2019) Re: Development and External Validation of a Nomogram Predicting Prognosis of Upper Tract Urothelial Carcinoma after Radical NephroureterectomyJournal of Urology, VOL. 202, NO. 6, (1093-1094), Online publication date: 1-Dec-2019.Laguna M (2018) Re: Impact of Diagnostic Ureteroscopy on Intravesical Recurrence in Patients Undergoing Radical Nephroureterectomy for Upper Tract Urothelial Cancer: A Systematic Review and Meta-AnalysisJournal of Urology, VOL. 199, NO. 4, (889-890), Online publication date: 1-Apr-2018. Volume 197Issue 5May 2017Page: 1208-1213Supplementary Materials Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.KeywordscarcinomaChinaurotheliumUnited Statesurinary tractMetricsAuthor Information Nirmish Singla Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author Dong Fang Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author Xiaohong Su Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author Zhengqing Bao Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author Zhenpeng Cao Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author Syed M. Jafri Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania More articles by this author Gengyan Xiong Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author Lei Zhang Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author Ryan Hutchinson Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author Arthur Sagalowsky Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author Yair Lotan Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author Xuesong Li Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author Liqun Zhou Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China More articles by this author Jay D. Raman Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania More articles by this author Vitaly Margulis Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author Expand All Advertisement PDF downloadLoading ...