Higher than expected and significantly increasing incidence of upper tract urothelial carcinoma. A population based study

Abstract

Purpose To register all cases of urothelial cancer and renal cell carcinoma (RCC) in Norway during 1999–2018 to obtain the contemporary incidence of UTUC and UTUC incidence relative to other urothelial cancers and RCC. Further to analyse possible changes over time regarding UTUC incidence, UTUC patient characteristics, tumour characteristics and survival. Methods 3502 cases registered with ICD code C65 and C66 during 1999–2018 at the Norwegian cancer registry were entered into a database. After a selection process 3096 cases were included in the study. The crude incidences of UTUC were calculated for each year adjusting for the corresponding population data. Age-standardized rates adjusting to the European standard population (2013) were calculated. Comparisons were made with other cases of urothelial cancer and RCC. For changes over time, the material was split into 5-year periods. Regression analysis was used to calculate yearly changes and for assessing statistical significance. Survival outcomes were calculated using the Kaplan–Meier method. Results The overall age-standardized incidence rate was 3.88, increasing from 3.21 to 4.70 from first to last 5-year periods. The increase affected all ages except those < 60 years of age, and were observed regardless of gender or anatomical location. UTUC constituted 11.8% of all urothelial cancers, increasing from 9.9 to 12.8%. Mean patient age at diagnosis increased from 71.5 to 73.4 years. The 5-years Cancer-specific survival improved from 57.4 to 65.4%. Conclusion The incidence of UTUC was higher than expected and increasing. Patient age at diagnosis was increasing.

Rising incidence rates and unaltered survival rates for primary upper urinary tract urothelial carcinoma: a Dutch population‐based study from 1993 to 2017

“…Two other population-based studies, one conducted in the UK and one in Denmark, describing the periods 1985-2009 and 1944-2003, respectively, also found an increase in UTUC incidence [20,21]. The most recent publication on trends in the incidence of UTUC was based on the Norwegian cancer registry, which reported a similar trend over time to that found in our study; an increase in incidence from 3.21 to 4.71 per 100 000 person-years during the period 1999 to 2018 [22].…”

“…57% in both studies) in 830 UTUC patients between 1995 and 2004 [ 38 ]. Contrary, the 5‐year cancer‐specific survival in Norway improved between 1999 and 2018 from 57.4% to 65.4% [ 22 ]. Although information on adjuvant treatment regarding UTUC was limited, the authors stated that this improvement might be explained by the increased use of peri‐operative chemotherapy and the introduction of immunotherapy in recent years.…”

The incidence and prevalence of upper tract urothelial carcinoma: a systematic review

“…Seven corresponding authors were contacted for the raw data of graphs in their respective articles, to which four authors [15][16][17][18] replied with this data. In total, eight papers required data extraction using WebPlotDigitizer (Additional file 2).…”

“…In total, 12 studies reported incidence of UTUC according to age [14,[17][18][19][20][21][22][23][24][25][26][27][28]. The measures used to report incidence varied widely between different studies.…”

Incidence and survival variations of upper tract urothelial cancer in Taiwan (2001–2010)

“…UTUC is a rare and under‐recognized malignancy with an incidence range of 1.2–4.7 cases per 100 000 person‐years globally. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 Although exposure to smoking, alcohol consumption, aromatic amines, arsenic, aristolochic acid and so on have been considered as factors highly associated with UTUC development, 10 identifying individuals with a high risk of UTUC is usually challenging. Smoking and alcohol consumption are usually related to other cancers, and the other specific exposures are quite difficult to assess.…”