Regional differences in upper tract urothelial carcinoma patients across the United States

Simone Morra; Lukas Scheipner; Andrea Baudo; Letizia Maria Ippolita Jannello; Mario de Angelis; Carolin Siech; Jordan A Goyal; Nawar Touma; Zhe Tian; Fred Saad; Gianluigi Califano; Roberto la Rocca; Marco Capece; Shahrokh F Shariat; Sascha Ahyai; Luca Carmignani; Ottavio de Cobelli; Gennaro Musi; Alberto Briganti; Felix K H Chun; Nicola Longo; Pierre I Karakiewicz

doi:10.1016/j.urolonc.2024.01.034

Regional differences in upper tract urothelial carcinoma patients across the United States

Urol Oncol. 2024 May;42(5):162.e1-162.e10. doi: 10.1016/j.urolonc.2024.01.034. Epub 2024 Feb 9.

Authors

Simone Morra¹, Lukas Scheipner², Andrea Baudo³, Letizia Maria Ippolita Jannello⁴, Mario de Angelis⁵, Carolin Siech⁶, Jordan A Goyal⁷, Nawar Touma⁷, Zhe Tian⁷, Fred Saad⁷, Gianluigi Califano⁸, Roberto la Rocca⁸, Marco Capece⁸, Shahrokh F Shariat⁹, Sascha Ahyai¹⁰, Luca Carmignani¹¹, Ottavio de Cobelli¹², Gennaro Musi¹², Alberto Briganti¹³, Felix K H Chun¹⁴, Nicola Longo⁸, Pierre I Karakiewicz⁷

Affiliations

¹ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy. Electronic address: [email protected].
² Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Medical University of Graz, Graz, Austria.
³ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IRCCS Policlinico San Donato, Milan, Italy.
⁴ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
⁵ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁶ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.
⁷ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
⁸ Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
⁹ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
¹⁰ Department of Urology, Medical University of Graz, Graz, Austria.
¹¹ Department of Urology, IRCCS Policlinico San Donato, Milan, Italy; Department of Urology, IRCCS Ospedale Galeazzi, Sant'Ambrogio, Milan, Italy.
¹² Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, Università degli Studi di Milano, Milan, Italy.
¹³ Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
¹⁴ Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.

PMID: 38336499
DOI: 10.1016/j.urolonc.2024.01.034

Abstract

Background: It is unknown whether regional differences in patient, tumor, and treatment characteristics of upper tract urothelial carcinoma (UTUC) patients exist and may potentially result in regional overall mortality (OM) differences. We tested for inter-regional differences, according to Surveillance, Epidemiology, and End Results (SEER) registries.

Methods: Using SEER database 2000 to 2016, patient (age, sex, race/ethnicity), tumor (location, grade) and treatment (nephroureterectomy, systemic therapy [ST]) characteristics of UTUC patients of all-stages were tabulated and graphically depicted in a stage-specific fashion (T_1-2N₀M₀ vs. T_3-4N₀M₀ vs. T_anyN_1-2M₀/T_anyN_anyM₁). Multivariable Cox regression (MCR) models tested for inter-regional differences in OM.

Results: Regarding T_1-2N₀M₀ patients, statistically significant differences existed for race/ethnicity (Caucasian 71 vs. 98%), location (renal pelvis: 55 vs. 67%), grade (high 60 vs. 83%) and ST (5.5 vs. 13.9%). In MCR models, registries 3 (Hazard ratio [HR]:1.39; P < 0.001) and 4 (HR:1.31; P = 0.01) independently predicted higher OM and Registry 8 (HR:0.64; P = 0.001) lower OM. Regarding T_3-4N₀M₀ patients, statistically significant differences existed for race/ethnicity (Caucasian 70 vs. 98%), location (renal pelvis: 67 vs. 76%), grade (high 84 vs. 94%) and ST (18.7 vs. 29.5%). In MCR models, registries 3 (HR:1.42; P < 0.001) and 4 (HR:1.31; P = 0.009) independently predicted higher OM. Regarding T_anyN_1-2M₀/T_anyN_anyM₁ patients, statistically significant differences existed for location (renal pelvis: 63 vs. 82%), grade (high 92 vs. 98%) and ST (53.4 vs. 58.8%). In MCR models, Registry 3 (HR:1.37; P = 0.004) independently predicted higher OM and Registry 2, (HR:0.78; P = 0.02) lower OM.

Conclusions: Inter-regional differences were recorded in patients, tumor, and treatment characteristics. Even after adjustment for these characteristics, OM differences persisted which may be indicative of regional differences in quality of care or expertise in UTUC management.

Keywords: SEER registries; Survival; Treatment variability; Upper tract urothelial carcinoma; regional differences.

MeSH terms

Carcinoma, Transitional Cell* / pathology
Humans
Kidney Neoplasms* / pathology
Retrospective Studies
SEER Program
United States / epidemiology
Ureteral Neoplasms* / pathology
Urinary Bladder Neoplasms*