Higher risk of urothelial carcinoma in the upper urinary tract than in the urinary bladder in hemodialysis patients

Abstract

Purpose This study used the a nationwide population-based retrospective cohort study with the claims data from the Taiwan National Health Insurance Research Database to investigate the risk of urothelial carcinoma (UC) for hemodialysis (HD) patients. Methods The study population consisted of 2689 patients with end-stage renal disease (ESRD) newly diagnosed in 2000-2002 and underwent maintenance HD. Then, 21,449 reference patients were collected without HD randomly selected and matched with sex and age. The exclusion criteria were previous long-term analgesics and Chinese medication usage. Incidence density rates of UC in upper urinary tract (UTUC) and bladder (UBUC) were estimated for both cohorts by the end of 2012. Hazard ratios (HRs) of UC were measured in association with HD, covariates, and comorbidity. Results The incidence of UC was significantly higher in the HD cohort than in the reference cohort for both UT (21.8 vs. 0.65 per 10,000 person-years) and UB (17.7 vs. 3.55 per 10,000 person-years). The multivariate Cox proportional hazard regression analysis showed that the HRs of UTUC in HD cohort was 33.3 (95% CI ¼ 15.9-69.5) and 5.14 for UBUC (95% CI ¼ 3. 24-8.15). The risk increased further for HD patients with comorbidity of hematuria, urinary tract infection (UTI) or hydronephrosis. Conclusion Patients with ESRD on HD are at a high risk of developing UC, especially UTUC in Taiwan. They will be paid more frequent to check urine analysis, urine cytology, and upper urinary tract survey. ARTICLE HISTORY

Mutational signatures in upper tract urothelial carcinoma define etiologically distinct subtypes with prognostic relevance

“…2B, Wilcoxon rank test); (2) Age, there is significantly higher number of signatures 1 and 5, attributed to clocklike mutational processes accumulated over cell divisions(18) (fig. 2C, Wilcoxon rank test); and (3) DSB, there is significantly higher number of signature 3 mutations, associated with failure of DNA double-strand break-repair by homologous recombination (fig. 2D, Wilcoxon rank test).…”

“…The epidemiology and clinicopathological characteristics of UTUC is largely influenced by its geographic distribution. Parts of East Asia such as Taiwan have a much higher UTUC prevalence, accounting for more than 30% of urothelial cancers (UCs)(1–3) compared to only 5-10% of UCs in Western populations(4). Chinese patients are more frequently female, of higher rate for kidney failure(5).…”

Association between urologic malignancies and end‐stage renal disease: A meta‐analysis

“…Weng et al . and Hsiao et al . used the same databases with relatively similar study duration periods.…”

“…An additional 38 articles were excluded for failing to meet the criteria: 30 articles did not report the outcome of interest, and eight articles were not observational studies. Studies by Stewart et al 17 , Maisonneuve et al 27 , Weng et al 26 and Hsiao et al 37 used the same databases with relatively similar study duration periods. Studies by Stewart et al 17 and Weng et al 26 provided more updated and comprehensive data, and thus they were included in the analysis.…”

Outcomes of stage�II‑IV upper‑tract urothelial carcinoma and adjuvant chemotherapy for locally advanced cancer

“…In the present study, 65.9% of the patients with UTUC were female. Although the majority of UTUC cases occur in men, the high prevalence of UTUC in Taiwan is notably impacted by the high use of Aristolochia fangchi by women for weight-loss and immune modulation to become healthy, which results in an increased female incidence in Taiwan compared with men (22). The present study aimed to determine whether adjuvant chemotherapy is beneficial for patients with high-stage UTUC.…”