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.
