Prognosis is deteriorating for upper tract urothelial cancer

Blogger's Note/Opinion: while this study is specific to England, there are some key observations which would be applicable elsewhere; one item of key interest and not specific to UTUC is minimally invasive surgery which some recent research indicates a less than favourable surgical mechanism (for a variety of reasons); there are blog posts on this site regarding the issue; note also that imagine of the ureters is often difficult (CT urogram is the favored imaging for suspicion of ureteral malignancy); this research should be of interest to Lynch Syndrome patients including ovarian cancer patients (and others) with widespread disease (re: extension (seeding) of malignancy to bladder....)

Prognosis is deteriorating for upper tract urothelial cancer: data for England 1985–2010 - Eylert - 2013 - BJU International - Wiley Online Library

Objective

• To ascertain current trends in the incidence and mortality rates for upper tract urothelial cancer (UTUC) and identify any relationship with age, stage at presentation, social deprivation and treatment method.

Patients and Methods

• We used national databases to collect the data: incidence, stage and survival data from the National Cancer Data Repository (NCDR) and British Association of Urological Surgeons (BAUS) audit database; mortality data from the Office for National Statistics (ONS); and treatment method data from the Hospital Episodes Statistics (HES).

Results

• The incidence of UTUC is increasing (from 1985 to 2009 it increased by 38% in men and 77% in women). It affects mainly those aged >60 years, and diagnoses are increasingly made in those aged >80 years. Diagnoses at advanced stage have increased from 45 to 80%.
• Mortality has risen faster than incidence; the overall 5-year survival rate has dropped from 60 to 48%. Survival is worst in stage IV disease and in patients aged ≥80 years; when analysed by age or stage group, survival rates are unchanged.
• Nephroureterectomy has increased by 75%, but endoscopic treatment, which only became available part way through the study period, now accounts for 11% of surgical interventions for UTUC, mainly in stage I disease and in the elderly.

Conclusions

• Despite sharing its risk factors with bladder cancer, current incidence and mortality trends for UTUC contrast with those in bladder cancer. Increasing use of cross-sectional imaging may explain some of the identified increased incidence. Higher incidence specifically in people >80 years, together with stage migration to more advanced cancers, are likely to have caused at least some of the observed increased mortality.
• Further study is required to answer the questions of whether there are other hitherto unidentified aetiological or prognostic factors; whether less aggressive treatment of UTUCs in the elderly is always justified; and whether the rising frequency of minimally invasive treatment means suboptimum oncological management.