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Incidence and Survival Outcomes of Upper Urinary Tract Urothelial Carcinoma - Expert Commentary

Upper urinary tract urothelial carcinoma (UTUC) constituted 5-10% of urothelial carcinomas. The management of UTUC has significantly changed in the last decade with the introduction of neoadjuvant chemotherapy options and kidney-sparing surgery (KSS) as an alternative to radical nephroureterectomy (RNU). Studying the trends in incidence, management approaches, and survival outcomes from large-scale cancer registries can shed light on the impact of these advances.


A recently published population-based study by van Doeveren et al. in BJU International evaluated the trends in incidence, disease management, and survival of UTUC in the Netherlands. The study evaluated 13,314 patients with primary UTUC between 1993 and 2017 based on records from the population-based Netherlands Cancer Registry (NCR).

The authors found that the age-standardized incidence rate of UTUC had increased from 2.0 in 1993 to 3.2 per 100,000 person-years in 2017. This corresponded to an approximate increase of 50% of new diagnoses. The increase in incidence was significant for metastatic UTUC (from 0.1 to 0.4) and superficial disease (Tis/Ta) (from 0.6 to 1.2). The gender distribution and percentage of patients who are younger than 60 remained unchanged. The investigators observed that between 2005-2017, the percentage of patients who received RNU decreased from 72.3% to 62.9%, and those who received KSS increased from 6% to 13.6%.

The study revealed that the 5-year relative survival remained unchanged from 1993 to 2017 and was estimated to be 57.0% for all patients, 85.7% for patients with superficial disease, and 69.6% for patients with organ-confined disease. A modest improvement of the 5-year survival has been noted in patients with non-organ confined disease (from 35.6% to 43.6%, Ptrend = 0.05).

Despite the increased incidence and changes in the treatment modalities, the survival outcomes of UTUC remained stable in the Netherlands. These data emphasize the need to develop more effective therapeutic interventions and to improve the utilization of proven treatments to improve clinical outcomes for these patients.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York

References:

  1. van Doeveren T, van der Mark M, van Leeuwen PJ, Boormans JL, Aben KKH. Rising incidence rates and unaltered survival for primary upper urinary tract urothelial carcinoma: a Dutch population‐based study from 1993 to 2017. BJU Int. 2021 Mar 10;doi.10.1111/bju.15389. PMID: 33690922


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