A multi-institutional comparison of clinicopathologic characteristics and oncologic outcomes of upper tract urothelial carcinoma in China and the United States

A multi-institutional comparison of clinicopathologic characteristics and oncologic outcomes of upper tract urothelial carcinoma in China and the United States - abstract

Purpose

To evaluate differences in clinicopathologic characteristics and oncologic outcomes between upper-tract urothelial carcinoma (UTUC) patients in China and the United States (U.S.).

Methods

Clinicopathologic and oncologic outcomes data of UTUC patients treated surgically at tertiary care medical facilities in the U.S. or China from 1998-2015 were retrospectively compiled. Baseline demographics, comorbidities, and pathologic features were evaluated. Oncologic endpoints including intravesical recurrence and cancer-specific survival (CSS) were obtained following exclusion of patients who received systemic chemotherapy. Multivariable Cox regression was performed to determine predictors of adverse oncologic outcomes for each country.

Results

775 UTUC patients were identified (451 China, 324 U.S.) with a median follow-up of 42 months. U.S. patients were more frequently male (65% vs. 44%, p<0.001), smokers (79% vs. 18%, p<0.001), had worse mean ASA score (2.7 vs. 2.2, p<0.001), and had prior bladder cancer (41% vs. 4%, p<0.001). Chinese patients more often had pre-operative hydronephrosis (56% vs. 40%, p<0.001), high-grade pathology (98% vs. 77%, p<0.001), muscle-invasion (64% vs. 38%, p<0.001), and nodal metastases (26% vs. 6%, p<0.001). U.S. patients had worse overall survival (OS) on Kaplan-Meier analysis (p=0.049), while country of origin did not predict local relapse or CSS.

Conclusion

Patient and disease characteristics of UTUC differ between Chinese and U.S. cohorts. Chinese patients appear relatively healthier at presentation but more often exhibit adverse pathologic features. While evaluation and management patterns may account for these variations, the pathologic findings may reflect differential underlying pathogenesis of disease, and additional study is warranted to further characterize these differences.

Keywords:

upper-tract urothelial carcinoma, epidemiology, prognosis, outcomes, risk factors